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You must answer in three paragraphs or less, using only information from the context block.
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How does the adequacy decision impact data transfers?
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CHAPTER V Transfers of personal data to third countries or international organisations Article 44 General principle for transfers Any transfer of personal data which are undergoing processing or are intended for processing after transfer to a third country or to an international organisation shall take place only if, subject to the other provisions of this Regulation, the conditions laid down in this Chapter are complied with by the controller and processor, including for onward transfers of personal data from the third country or an international organisation to another third country or to another international organisation. All provisions in this Chapter shall be applied in order to ensure that the level of protection of natural persons guaranteed by this Regulation is not undermined. L 119/60 EN Official Journal of the European Union 4.5.2016 Article 45 Transfers on the basis of an adequacy decision 1. A transfer of personal data to a third country or an international organisation may take place where the Commission has decided that the third country, a territory or one or more specified sectors within that third country, or the international organisation in question ensures an adequate level of protection. Such a transfer shall not require any specific authorisation. 2. When assessing the adequacy of the level of protection, the Commission shall, in particular, take account of the following elements: (a) the rule of law, respect for human rights and fundamental freedoms, relevant legislation, both general and sectoral, including concerning public security, defence, national security and criminal law and the access of public authorities to personal data, as well as the implementation of such legislation, data protection rules, professional rules and security measures, including rules for the onward transfer of personal data to another third country or international organisation which are complied with in that country or international organisation, case-law, as well as effective and enforceable data subject rights and effective administrative and judicial redress for the data subjects whose personal data are being transferred; (b) the existence and effective functioning of one or more independent supervisory authorities in the third country or to which an international organisation is subject, with responsibility for ensuring and enforcing compliance with the data protection rules, including adequate enforcement powers, for assisting and advising the data subjects in exercising their rights and for cooperation with the supervisory authorities of the Member States; and (c) the international commitments the third country or international organisation concerned has entered into, or other obligations arising from legally binding conventions or instruments as well as from its participation in multilateral or regional systems, in particular in relation to the protection of personal data. 3. The Commission, after assessing the adequacy of the level of protection, may decide, by means of implementing act, that a third country, a territory or one or more specified sectors within a third country, or an international organisation ensures an adequate level of protection within the meaning of paragraph 2 of this Article. The implementing act shall provide for a mechanism for a periodic review, at least every four years, which shall take into account all relevant developments in the third country or international organisation. The implementing act shall specify its territorial and sectoral application and, where applicable, identify the supervisory authority or authorities referred to in point (b) of paragraph 2 of this Article. The implementing act shall be adopted in accordance with the examination procedure referred to in Article 93(2). 4. The Commission shall, on an ongoing basis, monitor developments in third countries and international organisations that could affect the functioning of decisions adopted pursuant to paragraph 3 of this Article and decisions adopted on the basis of Article 25(6) of Directive 95/46/EC. 5. The Commission shall, where available information reveals, in particular following the review referred to in paragraph 3 of this Article, that a third country, a territory or one or more specified sectors within a third country, or an international organisation no longer ensures an adequate level of protection within the meaning of paragraph 2 of this Article, to the extent necessary, repeal, amend or suspend the decision referred to in paragraph 3 of this Article by means of implementing acts without retro-active effect. Those implementing acts shall be adopted in accordance with the examination procedure referred to in Article 93(2). On duly justified imperative grounds of urgency, the Commission shall adopt immediately applicable implementing acts in accordance with the procedure referred to in Article 93(3). 6. The Commission shall enter into consultations with the third country or international organisation with a view to remedying the situation giving rise to the decision made pursuant to paragraph 5. 7. A decision pursuant to paragraph 5 of this Article is without prejudice to transfers of personal data to the third country, a territory or one or more specified sectors within that third country, or the international organisation in question pursuant to Articles 46 to 49. 8. The Commission shall publish in the Official Journal of the European Union and on its website a list of the third countries, territories and specified sectors within a third country and international organisations for which it has decided that an adequate level of protection is or is no longer ensured. 4.5.2016 EN Official Journal of the European Union L 119/61 9. Decisions adopted by the Commission on the basis of Article 25(6) of Directive 95/46/EC shall remain in force until amended, replaced or repealed by a Commission Decision adopted in accordance with paragraph 3 or 5 of this Article. Article 46 Transfers subject to appropriate safeguards 1. In the absence of a decision pursuant to Article 45(3), a controller or processor may transfer personal data to a third country or an international organisation only if the controller or processor has provided appropriate safeguards, and on condition that enforceable data subject rights and effective legal remedies for data subjects are available. 2. The appropriate safeguards referred to in paragraph 1 may be provided for, without requiring any specific authorisation from a supervisory authority, by: (a) a legally binding and enforceable instrument between public authorities or bodies; (b) binding corporate rules in accordance with Article 47; (c) standard data protection clauses adopted by the Commission in accordance with the examination procedure referred to in Article 93(2); (d) standard data protection clauses adopted by a supervisory authority and approved by the Commission pursuant to the examination procedure referred to in Article 93(2); (e) an approved code of conduct pursuant to Article 40 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights; or (f) an approved certification mechanism pursuant to Article 42 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights. 3. Subject to the authorisation from the competent supervisory authority, the appropriate safeguards referred to in paragraph 1 may also be provided for, in particular, by: (a) contractual clauses between the controller or processor and the controller, processor or the recipient of the personal data in the third country or international organisation; or (b) provisions to be inserted into administrative arrangements between public authorities or bodies which include enforceable and effective data subject rights. 4. The supervisory authority shall apply the consistency mechanism referred to in Article 63 in the cases referred to in paragraph 3 of this Article. 5. Authorisations by a Member State or supervisory authority on the basis of Article 26(2) of Directive 95/46/EC shall remain valid until amended, replaced or repealed, if necessary, by that supervisory authority. Decisions adopted by the Commission on the basis of Article 26(4) of Directive 95/46/EC shall remain in force until amended, replaced or repealed, if necessary, by a Commission Decision adopted in accordance with paragraph 2 of this Article.
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System Instructions: You must answer only information from the context block. No external information can be used to supplement this. Context: CHAPTER V Transfers of personal data to third countries or international organisations Article 44 General principle for transfers Any transfer of personal data which are undergoing processing or are intended for processing after transfer to a third country or to an international organisation shall take place only if, subject to the other provisions of this Regulation, the conditions laid down in this Chapter are complied with by the controller and processor, including for onward transfers of personal data from the third country or an international organisation to another third country or to another international organisation. All provisions in this Chapter shall be applied in order to ensure that the level of protection of natural persons guaranteed by this Regulation is not undermined. L 119/60 EN Official Journal of the European Union 4.5.2016 Article 45 Transfers on the basis of an adequacy decision 1. A transfer of personal data to a third country or an international organisation may take place where the Commission has decided that the third country, a territory or one or more specified sectors within that third country, or the international organisation in question ensures an adequate level of protection. Such a transfer shall not require any specific authorisation. 2. When assessing the adequacy of the level of protection, the Commission shall, in particular, take account of the following elements: (a) the rule of law, respect for human rights and fundamental freedoms, relevant legislation, both general and sectoral, including concerning public security, defence, national security and criminal law and the access of public authorities to personal data, as well as the implementation of such legislation, data protection rules, professional rules and security measures, including rules for the onward transfer of personal data to another third country or international organisation which are complied with in that country or international organisation, case-law, as well as effective and enforceable data subject rights and effective administrative and judicial redress for the data subjects whose personal data are being transferred; (b) the existence and effective functioning of one or more independent supervisory authorities in the third country or to which an international organisation is subject, with responsibility for ensuring and enforcing compliance with the data protection rules, including adequate enforcement powers, for assisting and advising the data subjects in exercising their rights and for cooperation with the supervisory authorities of the Member States; and (c) the international commitments the third country or international organisation concerned has entered into, or other obligations arising from legally binding conventions or instruments as well as from its participation in multilateral or regional systems, in particular in relation to the protection of personal data. 3. The Commission, after assessing the adequacy of the level of protection, may decide, by means of implementing act, that a third country, a territory or one or more specified sectors within a third country, or an international organisation ensures an adequate level of protection within the meaning of paragraph 2 of this Article. The implementing act shall provide for a mechanism for a periodic review, at least every four years, which shall take into account all relevant developments in the third country or international organisation. The implementing act shall specify its territorial and sectoral application and, where applicable, identify the supervisory authority or authorities referred to in point (b) of paragraph 2 of this Article. The implementing act shall be adopted in accordance with the examination procedure referred to in Article 93(2). 4. The Commission shall, on an ongoing basis, monitor developments in third countries and international organisations that could affect the functioning of decisions adopted pursuant to paragraph 3 of this Article and decisions adopted on the basis of Article 25(6) of Directive 95/46/EC. 5. The Commission shall, where available information reveals, in particular following the review referred to in paragraph 3 of this Article, that a third country, a territory or one or more specified sectors within a third country, or an international organisation no longer ensures an adequate level of protection within the meaning of paragraph 2 of this Article, to the extent necessary, repeal, amend or suspend the decision referred to in paragraph 3 of this Article by means of implementing acts without retro-active effect. Those implementing acts shall be adopted in accordance with the examination procedure referred to in Article 93(2). On duly justified imperative grounds of urgency, the Commission shall adopt immediately applicable implementing acts in accordance with the procedure referred to in Article 93(3). 6. The Commission shall enter into consultations with the third country or international organisation with a view to remedying the situation giving rise to the decision made pursuant to paragraph 5. 7. A decision pursuant to paragraph 5 of this Article is without prejudice to transfers of personal data to the third country, a territory or one or more specified sectors within that third country, or the international organisation in question pursuant to Articles 46 to 49. 8. The Commission shall publish in the Official Journal of the European Union and on its website a list of the third countries, territories and specified sectors within a third country and international organisations for which it has decided that an adequate level of protection is or is no longer ensured. 4.5.2016 EN Official Journal of the European Union L 119/61 9. Decisions adopted by the Commission on the basis of Article 25(6) of Directive 95/46/EC shall remain in force until amended, replaced or repealed by a Commission Decision adopted in accordance with paragraph 3 or 5 of this Article. Article 46 Transfers subject to appropriate safeguards 1. In the absence of a decision pursuant to Article 45(3), a controller or processor may transfer personal data to a third country or an international organisation only if the controller or processor has provided appropriate safeguards, and on condition that enforceable data subject rights and effective legal remedies for data subjects are available. 2. The appropriate safeguards referred to in paragraph 1 may be provided for, without requiring any specific authorisation from a supervisory authority, by: (a) a legally binding and enforceable instrument between public authorities or bodies; (b) binding corporate rules in accordance with Article 47; (c) standard data protection clauses adopted by the Commission in accordance with the examination procedure referred to in Article 93(2); (d) standard data protection clauses adopted by a supervisory authority and approved by the Commission pursuant to the examination procedure referred to in Article 93(2); (e) an approved code of conduct pursuant to Article 40 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights; or (f) an approved certification mechanism pursuant to Article 42 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights. 3. Subject to the authorisation from the competent supervisory authority, the appropriate safeguards referred to in paragraph 1 may also be provided for, in particular, by: (a) contractual clauses between the controller or processor and the controller, processor or the recipient of the personal data in the third country or international organisation; or (b) provisions to be inserted into administrative arrangements between public authorities or bodies which include enforceable and effective data subject rights. 4. The supervisory authority shall apply the consistency mechanism referred to in Article 63 in the cases referred to in paragraph 3 of this Article. 5. Authorisations by a Member State or supervisory authority on the basis of Article 26(2) of Directive 95/46/EC shall remain valid until amended, replaced or repealed, if necessary, by that supervisory authority. Decisions adopted by the Commission on the basis of Article 26(4) of Directive 95/46/EC shall remain in force until amended, replaced or repealed, if necessary, by a Commission Decision adopted in accordance with paragraph 2 of this Article. Question: How does the adequacy decision impact data transfers?
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You must answer in three paragraphs or less, using only information from the context block.
EVIDENCE:
CHAPTER V Transfers of personal data to third countries or international organisations Article 44 General principle for transfers Any transfer of personal data which are undergoing processing or are intended for processing after transfer to a third country or to an international organisation shall take place only if, subject to the other provisions of this Regulation, the conditions laid down in this Chapter are complied with by the controller and processor, including for onward transfers of personal data from the third country or an international organisation to another third country or to another international organisation. All provisions in this Chapter shall be applied in order to ensure that the level of protection of natural persons guaranteed by this Regulation is not undermined. L 119/60 EN Official Journal of the European Union 4.5.2016 Article 45 Transfers on the basis of an adequacy decision 1. A transfer of personal data to a third country or an international organisation may take place where the Commission has decided that the third country, a territory or one or more specified sectors within that third country, or the international organisation in question ensures an adequate level of protection. Such a transfer shall not require any specific authorisation. 2. When assessing the adequacy of the level of protection, the Commission shall, in particular, take account of the following elements: (a) the rule of law, respect for human rights and fundamental freedoms, relevant legislation, both general and sectoral, including concerning public security, defence, national security and criminal law and the access of public authorities to personal data, as well as the implementation of such legislation, data protection rules, professional rules and security measures, including rules for the onward transfer of personal data to another third country or international organisation which are complied with in that country or international organisation, case-law, as well as effective and enforceable data subject rights and effective administrative and judicial redress for the data subjects whose personal data are being transferred; (b) the existence and effective functioning of one or more independent supervisory authorities in the third country or to which an international organisation is subject, with responsibility for ensuring and enforcing compliance with the data protection rules, including adequate enforcement powers, for assisting and advising the data subjects in exercising their rights and for cooperation with the supervisory authorities of the Member States; and (c) the international commitments the third country or international organisation concerned has entered into, or other obligations arising from legally binding conventions or instruments as well as from its participation in multilateral or regional systems, in particular in relation to the protection of personal data. 3. The Commission, after assessing the adequacy of the level of protection, may decide, by means of implementing act, that a third country, a territory or one or more specified sectors within a third country, or an international organisation ensures an adequate level of protection within the meaning of paragraph 2 of this Article. The implementing act shall provide for a mechanism for a periodic review, at least every four years, which shall take into account all relevant developments in the third country or international organisation. The implementing act shall specify its territorial and sectoral application and, where applicable, identify the supervisory authority or authorities referred to in point (b) of paragraph 2 of this Article. The implementing act shall be adopted in accordance with the examination procedure referred to in Article 93(2). 4. The Commission shall, on an ongoing basis, monitor developments in third countries and international organisations that could affect the functioning of decisions adopted pursuant to paragraph 3 of this Article and decisions adopted on the basis of Article 25(6) of Directive 95/46/EC. 5. The Commission shall, where available information reveals, in particular following the review referred to in paragraph 3 of this Article, that a third country, a territory or one or more specified sectors within a third country, or an international organisation no longer ensures an adequate level of protection within the meaning of paragraph 2 of this Article, to the extent necessary, repeal, amend or suspend the decision referred to in paragraph 3 of this Article by means of implementing acts without retro-active effect. Those implementing acts shall be adopted in accordance with the examination procedure referred to in Article 93(2). On duly justified imperative grounds of urgency, the Commission shall adopt immediately applicable implementing acts in accordance with the procedure referred to in Article 93(3). 6. The Commission shall enter into consultations with the third country or international organisation with a view to remedying the situation giving rise to the decision made pursuant to paragraph 5. 7. A decision pursuant to paragraph 5 of this Article is without prejudice to transfers of personal data to the third country, a territory or one or more specified sectors within that third country, or the international organisation in question pursuant to Articles 46 to 49. 8. The Commission shall publish in the Official Journal of the European Union and on its website a list of the third countries, territories and specified sectors within a third country and international organisations for which it has decided that an adequate level of protection is or is no longer ensured. 4.5.2016 EN Official Journal of the European Union L 119/61 9. Decisions adopted by the Commission on the basis of Article 25(6) of Directive 95/46/EC shall remain in force until amended, replaced or repealed by a Commission Decision adopted in accordance with paragraph 3 or 5 of this Article. Article 46 Transfers subject to appropriate safeguards 1. In the absence of a decision pursuant to Article 45(3), a controller or processor may transfer personal data to a third country or an international organisation only if the controller or processor has provided appropriate safeguards, and on condition that enforceable data subject rights and effective legal remedies for data subjects are available. 2. The appropriate safeguards referred to in paragraph 1 may be provided for, without requiring any specific authorisation from a supervisory authority, by: (a) a legally binding and enforceable instrument between public authorities or bodies; (b) binding corporate rules in accordance with Article 47; (c) standard data protection clauses adopted by the Commission in accordance with the examination procedure referred to in Article 93(2); (d) standard data protection clauses adopted by a supervisory authority and approved by the Commission pursuant to the examination procedure referred to in Article 93(2); (e) an approved code of conduct pursuant to Article 40 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights; or (f) an approved certification mechanism pursuant to Article 42 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights. 3. Subject to the authorisation from the competent supervisory authority, the appropriate safeguards referred to in paragraph 1 may also be provided for, in particular, by: (a) contractual clauses between the controller or processor and the controller, processor or the recipient of the personal data in the third country or international organisation; or (b) provisions to be inserted into administrative arrangements between public authorities or bodies which include enforceable and effective data subject rights. 4. The supervisory authority shall apply the consistency mechanism referred to in Article 63 in the cases referred to in paragraph 3 of this Article. 5. Authorisations by a Member State or supervisory authority on the basis of Article 26(2) of Directive 95/46/EC shall remain valid until amended, replaced or repealed, if necessary, by that supervisory authority. Decisions adopted by the Commission on the basis of Article 26(4) of Directive 95/46/EC shall remain in force until amended, replaced or repealed, if necessary, by a Commission Decision adopted in accordance with paragraph 2 of this Article.
USER:
How does the adequacy decision impact data transfers?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 15 | 8 | 1,306 | null | 145 |
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
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Explain the benefits for a tech company of upgrading their frontend codebase from the AngularJS framework to the modern Angular framework in less than 200 words.
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The Risks of Sticking with Outdated Frameworks Security Vulnerabilities Every software framework, including Angular, has vulnerabilities that are discovered and patched over time. Running an outdated version means your application is exposed to known security issues that could have been mitigated with an upgrade. For example, Angular has had several security updates over the years addressing issues such as Cross-Site Scripting (XSS) and dependency vulnerabilities. By not upgrading, you leave your application susceptible to attacks that can compromise user data and damage your company's reputation. Example: In AngularJs 1.6.3, a critical security vulnerability was discovered that allowed attackers to execute arbitrary JavaScript code via the ngSanitize service. This issue was patched in a subsequent release. Companies still running Angular 1.6.3 or earlier are at risk of exploitation. Despite Angular 1.6.3 being an old version, it serves as an example because many legacy systems still run on AngularJS (Angular 1.x), and these systems are particularly vulnerable if not properly maintained. Performance Improvements Each new version of Angular introduces performance optimizations that make your application faster and more efficient. These improvements are often the result of extensive research and development by the Angular team, and they can have a significant impact on your application's load times and responsiveness. Example: Angular 9 introduced the Ivy compiler, which drastically reduced the size of compiled JavaScript bundles, leading to faster load times and improved performance. Applications that have not upgraded to Angular 9 or later are missing out on these substantial gains. Compatibility and Support Frameworks evolve to support new web standards, browser features, and third-party integrations. Running an outdated version of Angular can lead to compatibility issues with modern tools and libraries, making it harder to integrate new features or technologies into your application. Example: Angular 12 introduced strict mode, which improves maintainability and reduces the likelihood of runtime errors. It also provides better support for TypeScript 4.2, which includes new language features and performance enhancements. Sticking with an older version may result in compatibility issues and technical debt. Developer Satisfaction Developer satisfaction is crucial for retaining top talent and ensuring high productivity levels. Developers prefer working with the latest technologies to stay current with industry trends and advance their careers. Using an outdated tech stack can lead to frustration and decreased motivation, as developers may feel they are missing out on learning and growth opportunities. Nobody wants to work with old technologies that do not provide the modern conveniences, performance improvements, and security features available in newer versions. Example: A team of developers working with an outdated version of Angular might feel demotivated compared to their peers who are using the latest version with advanced features and improved tooling. This can lead to higher turnover rates as developers seek opportunities that allow them to work with cutting-edge technologies. Compliance and Regulatory Requirements Many industries, especially those dealing with sensitive information like finance and healthcare, are subject to strict regulatory requirements. Using outdated software can lead to non-compliance, resulting in fines and legal consequences. Regulatory bodies often require that software be up-to-date and free of known vulnerabilities. Example: In the banking sector, projects are often marked as security risks if they use outdated npm packages with known vulnerabilities. This non-compliance can lead to audits and penalties. Tools like Black Duck and SonarQube (Sonar) scans are frequently used to ensure compliance by identifying and reporting outdated or vulnerable dependencies. Black Duck, for instance, provides detailed reports on open-source component risks, helping teams understand the implications of using outdated libraries. Current Angular Versions As of June 2024, the current supported versions of Angular are 18, 17, 16. Angular follows a regular release cycle with Long-Term Support (LTS) versions that receive updates for an extended period (12 months), providing stability and security for production applications. Unsupported Angular Versions It's important to be aware of the Angular versions that are no longer supported, as they do not receive security updates or bug fixes. Angular versions v2 to v15 are no longer supported. Using these unsupported versions can expose your application to security risks and compatibility issues. Overcoming the Resistance to Upgrade Managers often resist upgrading frameworks due to concerns about the perceived disruption to business delivery. However, the risks associated with running outdated software can far outweigh the temporary inconvenience of an upgrade. Here are some strategies to help convince your manager: Highlight Security Risks: Emphasize the importance of security in protecting user data and maintaining trust. Provide examples of high-profile security breaches that were the result of outdated software. Explain that the cost of a security incident, in terms of both financial impact and reputation damage, can be far greater than the cost of an upgrade. Example: The Equifax data breach in 2017, which exposed the personal information of 147 million people, was partly due to an unpatched vulnerability in a web application framework. This breach resulted in a $700 million settlement. Demonstrate Cost Savings: While the initial investment in upgrading may seem high, it can lead to long-term cost savings by reducing technical debt, minimizing downtime, and improving developer efficiency. Provide a cost-benefit analysis that compares the costs of an upgrade to the potential costs of security breaches, performance issues, and maintenance of outdated code. Example: A study by IBM found that the average cost of a data breach is $3.86 million. Investing in regular upgrades can mitigate these risks and save significant costs in the long run. Showcase Success Stories: Provide case studies of companies that have successfully upgraded their frameworks and reaped the benefits. Highlight improvements in security, performance, and developer productivity. This can help alleviate fears and demonstrate the tangible benefits of staying up-to-date. Example: A major e-commerce company upgraded from AngularJS to Angular 10 and saw a 30% improvement in page load times, resulting in a 15% increase in user engagement and a 10% boost in sales. Plan for Minimal Disruption: Develop a detailed upgrade plan that minimizes disruption to business delivery. This can include phased rollouts, thorough testing, and parallel development to ensure a smooth transition. Demonstrating a well-thought-out plan can help reassure managers that the upgrade will not negatively impact ongoing projects. Example: Conduct a pilot upgrade with a smaller, less critical part of the application to identify potential issues and develop solutions before rolling out the upgrade to the entire system. Creating a Framework or Developer Experience (DX) Team One effective strategy to ensure regular upgrades and maintenance of frameworks is to establish a dedicated Framework or Developer Experience (DX) team. This team can take responsibility for monitoring updates, assessing their impact, and planning upgrades without disrupting the core business activities. Example: A large tech company established a DX team tasked with maintaining the development environment and ensuring all frameworks and libraries are up-to-date. This team conducted regular audits using tools like Black Duck and SonarQube to identify outdated dependencies and potential security risks. They then worked with development teams to plan and implement upgrades in a phased and controlled manner, ensuring minimal disruption to ongoing projects. Example: A financial institution formed a Framework Team to handle all aspects of framework maintenance, including Angular upgrades. This team used automated tools to scan for vulnerabilities and compliance issues, producing regular reports and actionable insights. By centralizing this responsibility, the institution was able to stay compliant with regulatory requirements and avoid potential security risks associated with outdated software.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Explain the benefits for a tech company of upgrading their frontend codebase from the AngularJS framework to the modern Angular framework in less than 200 words. <TEXT> The Risks of Sticking with Outdated Frameworks Security Vulnerabilities Every software framework, including Angular, has vulnerabilities that are discovered and patched over time. Running an outdated version means your application is exposed to known security issues that could have been mitigated with an upgrade. For example, Angular has had several security updates over the years addressing issues such as Cross-Site Scripting (XSS) and dependency vulnerabilities. By not upgrading, you leave your application susceptible to attacks that can compromise user data and damage your company's reputation. Example: In AngularJs 1.6.3, a critical security vulnerability was discovered that allowed attackers to execute arbitrary JavaScript code via the ngSanitize service. This issue was patched in a subsequent release. Companies still running Angular 1.6.3 or earlier are at risk of exploitation. Despite Angular 1.6.3 being an old version, it serves as an example because many legacy systems still run on AngularJS (Angular 1.x), and these systems are particularly vulnerable if not properly maintained. Performance Improvements Each new version of Angular introduces performance optimizations that make your application faster and more efficient. These improvements are often the result of extensive research and development by the Angular team, and they can have a significant impact on your application's load times and responsiveness. Example: Angular 9 introduced the Ivy compiler, which drastically reduced the size of compiled JavaScript bundles, leading to faster load times and improved performance. Applications that have not upgraded to Angular 9 or later are missing out on these substantial gains. Compatibility and Support Frameworks evolve to support new web standards, browser features, and third-party integrations. Running an outdated version of Angular can lead to compatibility issues with modern tools and libraries, making it harder to integrate new features or technologies into your application. Example: Angular 12 introduced strict mode, which improves maintainability and reduces the likelihood of runtime errors. It also provides better support for TypeScript 4.2, which includes new language features and performance enhancements. Sticking with an older version may result in compatibility issues and technical debt. Developer Satisfaction Developer satisfaction is crucial for retaining top talent and ensuring high productivity levels. Developers prefer working with the latest technologies to stay current with industry trends and advance their careers. Using an outdated tech stack can lead to frustration and decreased motivation, as developers may feel they are missing out on learning and growth opportunities. Nobody wants to work with old technologies that do not provide the modern conveniences, performance improvements, and security features available in newer versions. Example: A team of developers working with an outdated version of Angular might feel demotivated compared to their peers who are using the latest version with advanced features and improved tooling. This can lead to higher turnover rates as developers seek opportunities that allow them to work with cutting-edge technologies. Compliance and Regulatory Requirements Many industries, especially those dealing with sensitive information like finance and healthcare, are subject to strict regulatory requirements. Using outdated software can lead to non-compliance, resulting in fines and legal consequences. Regulatory bodies often require that software be up-to-date and free of known vulnerabilities. Example: In the banking sector, projects are often marked as security risks if they use outdated npm packages with known vulnerabilities. This non-compliance can lead to audits and penalties. Tools like Black Duck and SonarQube (Sonar) scans are frequently used to ensure compliance by identifying and reporting outdated or vulnerable dependencies. Black Duck, for instance, provides detailed reports on open-source component risks, helping teams understand the implications of using outdated libraries. Current Angular Versions As of June 2024, the current supported versions of Angular are 18, 17, 16. Angular follows a regular release cycle with Long-Term Support (LTS) versions that receive updates for an extended period (12 months), providing stability and security for production applications. Unsupported Angular Versions It's important to be aware of the Angular versions that are no longer supported, as they do not receive security updates or bug fixes. Angular versions v2 to v15 are no longer supported. Using these unsupported versions can expose your application to security risks and compatibility issues. Overcoming the Resistance to Upgrade Managers often resist upgrading frameworks due to concerns about the perceived disruption to business delivery. However, the risks associated with running outdated software can far outweigh the temporary inconvenience of an upgrade. Here are some strategies to help convince your manager: Highlight Security Risks: Emphasize the importance of security in protecting user data and maintaining trust. Provide examples of high-profile security breaches that were the result of outdated software. Explain that the cost of a security incident, in terms of both financial impact and reputation damage, can be far greater than the cost of an upgrade. Example: The Equifax data breach in 2017, which exposed the personal information of 147 million people, was partly due to an unpatched vulnerability in a web application framework. This breach resulted in a $700 million settlement. Demonstrate Cost Savings: While the initial investment in upgrading may seem high, it can lead to long-term cost savings by reducing technical debt, minimizing downtime, and improving developer efficiency. Provide a cost-benefit analysis that compares the costs of an upgrade to the potential costs of security breaches, performance issues, and maintenance of outdated code. Example: A study by IBM found that the average cost of a data breach is $3.86 million. Investing in regular upgrades can mitigate these risks and save significant costs in the long run. Showcase Success Stories: Provide case studies of companies that have successfully upgraded their frameworks and reaped the benefits. Highlight improvements in security, performance, and developer productivity. This can help alleviate fears and demonstrate the tangible benefits of staying up-to-date. Example: A major e-commerce company upgraded from AngularJS to Angular 10 and saw a 30% improvement in page load times, resulting in a 15% increase in user engagement and a 10% boost in sales. Plan for Minimal Disruption: Develop a detailed upgrade plan that minimizes disruption to business delivery. This can include phased rollouts, thorough testing, and parallel development to ensure a smooth transition. Demonstrating a well-thought-out plan can help reassure managers that the upgrade will not negatively impact ongoing projects. Example: Conduct a pilot upgrade with a smaller, less critical part of the application to identify potential issues and develop solutions before rolling out the upgrade to the entire system. Creating a Framework or Developer Experience (DX) Team One effective strategy to ensure regular upgrades and maintenance of frameworks is to establish a dedicated Framework or Developer Experience (DX) team. This team can take responsibility for monitoring updates, assessing their impact, and planning upgrades without disrupting the core business activities. Example: A large tech company established a DX team tasked with maintaining the development environment and ensuring all frameworks and libraries are up-to-date. This team conducted regular audits using tools like Black Duck and SonarQube to identify outdated dependencies and potential security risks. They then worked with development teams to plan and implement upgrades in a phased and controlled manner, ensuring minimal disruption to ongoing projects. Example: A financial institution formed a Framework Team to handle all aspects of framework maintenance, including Angular upgrades. This team used automated tools to scan for vulnerabilities and compliance issues, producing regular reports and actionable insights. By centralizing this responsibility, the institution was able to stay compliant with regulatory requirements and avoid potential security risks associated with outdated software. https://dev.to/this-is-angular/the-importance-of-upgrading-frameworks-a-case-for-angular-5c91
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
The Risks of Sticking with Outdated Frameworks Security Vulnerabilities Every software framework, including Angular, has vulnerabilities that are discovered and patched over time. Running an outdated version means your application is exposed to known security issues that could have been mitigated with an upgrade. For example, Angular has had several security updates over the years addressing issues such as Cross-Site Scripting (XSS) and dependency vulnerabilities. By not upgrading, you leave your application susceptible to attacks that can compromise user data and damage your company's reputation. Example: In AngularJs 1.6.3, a critical security vulnerability was discovered that allowed attackers to execute arbitrary JavaScript code via the ngSanitize service. This issue was patched in a subsequent release. Companies still running Angular 1.6.3 or earlier are at risk of exploitation. Despite Angular 1.6.3 being an old version, it serves as an example because many legacy systems still run on AngularJS (Angular 1.x), and these systems are particularly vulnerable if not properly maintained. Performance Improvements Each new version of Angular introduces performance optimizations that make your application faster and more efficient. These improvements are often the result of extensive research and development by the Angular team, and they can have a significant impact on your application's load times and responsiveness. Example: Angular 9 introduced the Ivy compiler, which drastically reduced the size of compiled JavaScript bundles, leading to faster load times and improved performance. Applications that have not upgraded to Angular 9 or later are missing out on these substantial gains. Compatibility and Support Frameworks evolve to support new web standards, browser features, and third-party integrations. Running an outdated version of Angular can lead to compatibility issues with modern tools and libraries, making it harder to integrate new features or technologies into your application. Example: Angular 12 introduced strict mode, which improves maintainability and reduces the likelihood of runtime errors. It also provides better support for TypeScript 4.2, which includes new language features and performance enhancements. Sticking with an older version may result in compatibility issues and technical debt. Developer Satisfaction Developer satisfaction is crucial for retaining top talent and ensuring high productivity levels. Developers prefer working with the latest technologies to stay current with industry trends and advance their careers. Using an outdated tech stack can lead to frustration and decreased motivation, as developers may feel they are missing out on learning and growth opportunities. Nobody wants to work with old technologies that do not provide the modern conveniences, performance improvements, and security features available in newer versions. Example: A team of developers working with an outdated version of Angular might feel demotivated compared to their peers who are using the latest version with advanced features and improved tooling. This can lead to higher turnover rates as developers seek opportunities that allow them to work with cutting-edge technologies. Compliance and Regulatory Requirements Many industries, especially those dealing with sensitive information like finance and healthcare, are subject to strict regulatory requirements. Using outdated software can lead to non-compliance, resulting in fines and legal consequences. Regulatory bodies often require that software be up-to-date and free of known vulnerabilities. Example: In the banking sector, projects are often marked as security risks if they use outdated npm packages with known vulnerabilities. This non-compliance can lead to audits and penalties. Tools like Black Duck and SonarQube (Sonar) scans are frequently used to ensure compliance by identifying and reporting outdated or vulnerable dependencies. Black Duck, for instance, provides detailed reports on open-source component risks, helping teams understand the implications of using outdated libraries. Current Angular Versions As of June 2024, the current supported versions of Angular are 18, 17, 16. Angular follows a regular release cycle with Long-Term Support (LTS) versions that receive updates for an extended period (12 months), providing stability and security for production applications. Unsupported Angular Versions It's important to be aware of the Angular versions that are no longer supported, as they do not receive security updates or bug fixes. Angular versions v2 to v15 are no longer supported. Using these unsupported versions can expose your application to security risks and compatibility issues. Overcoming the Resistance to Upgrade Managers often resist upgrading frameworks due to concerns about the perceived disruption to business delivery. However, the risks associated with running outdated software can far outweigh the temporary inconvenience of an upgrade. Here are some strategies to help convince your manager: Highlight Security Risks: Emphasize the importance of security in protecting user data and maintaining trust. Provide examples of high-profile security breaches that were the result of outdated software. Explain that the cost of a security incident, in terms of both financial impact and reputation damage, can be far greater than the cost of an upgrade. Example: The Equifax data breach in 2017, which exposed the personal information of 147 million people, was partly due to an unpatched vulnerability in a web application framework. This breach resulted in a $700 million settlement. Demonstrate Cost Savings: While the initial investment in upgrading may seem high, it can lead to long-term cost savings by reducing technical debt, minimizing downtime, and improving developer efficiency. Provide a cost-benefit analysis that compares the costs of an upgrade to the potential costs of security breaches, performance issues, and maintenance of outdated code. Example: A study by IBM found that the average cost of a data breach is $3.86 million. Investing in regular upgrades can mitigate these risks and save significant costs in the long run. Showcase Success Stories: Provide case studies of companies that have successfully upgraded their frameworks and reaped the benefits. Highlight improvements in security, performance, and developer productivity. This can help alleviate fears and demonstrate the tangible benefits of staying up-to-date. Example: A major e-commerce company upgraded from AngularJS to Angular 10 and saw a 30% improvement in page load times, resulting in a 15% increase in user engagement and a 10% boost in sales. Plan for Minimal Disruption: Develop a detailed upgrade plan that minimizes disruption to business delivery. This can include phased rollouts, thorough testing, and parallel development to ensure a smooth transition. Demonstrating a well-thought-out plan can help reassure managers that the upgrade will not negatively impact ongoing projects. Example: Conduct a pilot upgrade with a smaller, less critical part of the application to identify potential issues and develop solutions before rolling out the upgrade to the entire system. Creating a Framework or Developer Experience (DX) Team One effective strategy to ensure regular upgrades and maintenance of frameworks is to establish a dedicated Framework or Developer Experience (DX) team. This team can take responsibility for monitoring updates, assessing their impact, and planning upgrades without disrupting the core business activities. Example: A large tech company established a DX team tasked with maintaining the development environment and ensuring all frameworks and libraries are up-to-date. This team conducted regular audits using tools like Black Duck and SonarQube to identify outdated dependencies and potential security risks. They then worked with development teams to plan and implement upgrades in a phased and controlled manner, ensuring minimal disruption to ongoing projects. Example: A financial institution formed a Framework Team to handle all aspects of framework maintenance, including Angular upgrades. This team used automated tools to scan for vulnerabilities and compliance issues, producing regular reports and actionable insights. By centralizing this responsibility, the institution was able to stay compliant with regulatory requirements and avoid potential security risks associated with outdated software.
USER:
Explain the benefits for a tech company of upgrading their frontend codebase from the AngularJS framework to the modern Angular framework in less than 200 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 26 | 1,227 | null | 840 |
Answer in a full sentence, no less than 50 words, and cite the part of the text that supports your statement.
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According to this article, what are the advantages of a Balloon Loan?
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**Balloon Payment: What It Is, How It Works** A balloon payment is the final amount due on a loan that is structured as a series of small monthly payments followed by a single much larger sum at the end of the loan period. The early payments may be all or almost all payments of interest owed on the loan, with the balloon payment being the principal of the loan. This type of loan is known as a balloon loan. The balloon home mortgage loan became common in the years before the 2007-2008 financial crisis. It allowed people eager to buy a home to obtain a mortgage payment that they could afford, at least in the early years. The balloon loan did not disappear with the financial crisis but is now more often used for business loans. A project can be financed with a loan that allows for minimal payments early on, with the balloon payment due only when the project is earning a return on the investment. A balloon payment is a type of loan structured so that the last payment is far larger than prior payments. Balloon payments are an option for home mortgages, auto loans, and business loans. Borrowers have lower initial monthly payments under a balloon loan. The interest rate is usually higher for a balloon loan, and only borrowers with high creditworthiness are considered. The balloon payment may be a weighted payment amount or, under an interest-only payment plan, be the full balance of the principal due. Understanding Balloon Payments As the term "balloon" suggests, the final payment on this type of loan is significantly large. In recent years, balloon payments have been more common in commercial lending than in consumer lending. It allows a commercial lender to keep short-term costs lower and take care of the balloon payment with future earnings. The same logic is used by individual homebuyers, but the risks are greater. Homebuyers are keeping their short-term costs low while assuming that their incomes will be far greater when the balloon payment comes due, that they will be able to refinance their mortgage before it is due, or that they can sell the house and pay off the entire mortgage before the balloon payment comes due. That strategy failed in the 2008-2009 financial crisis, when homeowners who financed their purchases with balloon mortgages found it impossible to sell their homes at a price high enough to pay off the amount they had borrowed. Balloon payments are often packaged into two-step mortgages. In this financing structure, a borrower receives an introductory and often lower interest rate at the start of their loan. Then, the loan shifts to a higher interest rate after an initial borrowing period. Balloon Payment Examples A balloon debt structure can be implemented for any type of debt. It's most commonly used in mortgages, auto loans, and business loans. Mortgage The balloon mortgage is rarely used for traditional 15-year or 30-year mortgages since lenders don't want to wait that long to get their money back. For balloon mortgages, lenders prefer a five-year to ten-year term. Interest-only balloon mortgages are available primarily to high-net-worth individuals who can afford large down payments. They are often taken with the intention of refinancing before the balloon payment is due. Balloon Loan vs. ARM A balloon loan is sometimes confused with an adjustable-rate mortgage (ARM). With an ARM, the borrower receives an introductory rate for a set amount of time, usually for one to five years. The interest rate resets at that point and might continue to reset periodically until the loan has been fully repaid. The incentive is a very low-interest rate at the beginning, compared to the fixed-rate mortgage rate. The downside is the potential for a substantially higher rate down the road. Business Loan It is usually easier for a business to secure a balloon loan if the business has a proven financial history and favorable credit record. An established business can be in a better position than an individual wage-earner to raise sufficient money to pay off the balloon payment. For this reason, lenders often consider businesses less risky than individual consumers for business loans. Balloon payments can be strategically used by a business to finance short-term needs. The business may draw on a balloon loan with no intention of holding the debt to the end of the term. Instead, the company can use the money to repay the loan in full before the end of the loan term. Options for Avoiding a Balloon Payment A borrower has a couple of ways to get rid of a looming payment. In addition to extinguishing the debt by paying off the balloon payment, a borrower can: Refinance the loan. A lender may be willing to work with a borrower to repurpose the debt into a different loan vehicle or modify the terms of the original agreement. Sell the underlying asset. If the balloon payment is due to the purchase of an asset, a borrower may be forced to liquidate the holding to avoid defaulting on the loan. Pay principal upfront. Though not required, a borrower may be able to pay a portion of the debt early. Any payment made more than the interest assessment will be applied to the principal balance. Check with your lender to ensure there are no prepayment penalties or fees. Negotiate an extension. Similar to refinancing, an extension changes the terms of the prior loan. However, instead of receiving a new deal, an extension will simply push out the timing of the balloon payment. You'll likely have the same payment terms as before but with different obligation dates. Balloon loans usually require collateral. For home or car loans, the lender may require a lien on the property being purchased. Should you default on your loan and not be able to satisfy the balloon payment, the lender has a legal claim to seize the property. Advantages of Balloon Payments The obvious advantage of balloon payments is the low initial payment requirement. The monthly balloon payment amount during the fixed period is generally less than the payment amount of a fully amortized loan. The timing of the payment size may mesh well with the borrower's income expectations. As the borrower's salary increases due to career progression, the debt obligation will rise as well. A balloon note or loan often has a shorter underwriting process compared to other loans. For this reason, there may be lower administrative or transaction fees in securing the loan. A borrower may also not be required to show as much documentation for this type of loan, as balloon mortgages often do not require a home appraisal as part of loan closing. A balloon payment structure is strategically advantageous for some borrowers. For example, people who flip houses can secure lower upfront monthly payments. The borrower has time to remodel the house and sell it before the balloon payment is due. This allows borrowers to preserve future cash flow for other purposes. Disadvantages of Balloon Payments Balloon payments can be a big problem in a falling housing market. As home prices decline, homeowners may be unable to sell their homes for enough to cover the balloon payment, and they might be unable to sell at any price. For home flippers, this means getting stuck with a high-interest rate loan should sales stall. Borrowers often have no choice but to default on their loans and enter foreclosure, regardless of their household incomes, when faced with a balloon payment they cannot afford. This results in the loss of the borrower's home. Some will be able to take out another loan to cover the upcoming balloon mortgage payment, but this puts a tremendous strain on a family's finances. Balloon mortgages and auto loans may be difficult to refinance depending on the amount of equity that has been paid off. The loans may only pay interest early on. In this case, the owner may have little-to-no equity in the property despite making consistent payments for years. These types of loans can be harder to qualify for. Because principal payments are deferred, lenders often prefer borrowers with a high credit score or high down payment. In addition, to compensate for the flexibility of the principal obligation and increased risk for the lender, lenders usually charge higher interest rates for balloon debt compared to other types of loans. What Is a Balloon Payment? A balloon payment is a lump sum principal balance that is due at the end of a loan term. The borrower pays much smaller monthly payments until the balloon payment is due. These payments may be entirely or almost entirely interest on the loan rather than principal. Borrowers are assuming that they can refinance the mortgage or sell the home at a profit before the balloon payment falls due. If the housing market takes an unexpected downturn and their home loses value, that strategy may fail.
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[Instructions] ======= Answer in a full sentence, no less than 50 words, and cite the part of the text that supports your statement. [Query] ======= According to this article, what are the advantages of a Balloon Loan? [Context] ======= **Balloon Payment: What It Is, How It Works** A balloon payment is the final amount due on a loan that is structured as a series of small monthly payments followed by a single much larger sum at the end of the loan period. The early payments may be all or almost all payments of interest owed on the loan, with the balloon payment being the principal of the loan. This type of loan is known as a balloon loan. The balloon home mortgage loan became common in the years before the 2007-2008 financial crisis. It allowed people eager to buy a home to obtain a mortgage payment that they could afford, at least in the early years. The balloon loan did not disappear with the financial crisis but is now more often used for business loans. A project can be financed with a loan that allows for minimal payments early on, with the balloon payment due only when the project is earning a return on the investment. A balloon payment is a type of loan structured so that the last payment is far larger than prior payments. Balloon payments are an option for home mortgages, auto loans, and business loans. Borrowers have lower initial monthly payments under a balloon loan. The interest rate is usually higher for a balloon loan, and only borrowers with high creditworthiness are considered. The balloon payment may be a weighted payment amount or, under an interest-only payment plan, be the full balance of the principal due. Understanding Balloon Payments As the term "balloon" suggests, the final payment on this type of loan is significantly large. In recent years, balloon payments have been more common in commercial lending than in consumer lending. It allows a commercial lender to keep short-term costs lower and take care of the balloon payment with future earnings. The same logic is used by individual homebuyers, but the risks are greater. Homebuyers are keeping their short-term costs low while assuming that their incomes will be far greater when the balloon payment comes due, that they will be able to refinance their mortgage before it is due, or that they can sell the house and pay off the entire mortgage before the balloon payment comes due. That strategy failed in the 2008-2009 financial crisis, when homeowners who financed their purchases with balloon mortgages found it impossible to sell their homes at a price high enough to pay off the amount they had borrowed. Balloon payments are often packaged into two-step mortgages. In this financing structure, a borrower receives an introductory and often lower interest rate at the start of their loan. Then, the loan shifts to a higher interest rate after an initial borrowing period. Balloon Payment Examples A balloon debt structure can be implemented for any type of debt. It's most commonly used in mortgages, auto loans, and business loans. Mortgage The balloon mortgage is rarely used for traditional 15-year or 30-year mortgages since lenders don't want to wait that long to get their money back. For balloon mortgages, lenders prefer a five-year to ten-year term. Interest-only balloon mortgages are available primarily to high-net-worth individuals who can afford large down payments. They are often taken with the intention of refinancing before the balloon payment is due. Balloon Loan vs. ARM A balloon loan is sometimes confused with an adjustable-rate mortgage (ARM). With an ARM, the borrower receives an introductory rate for a set amount of time, usually for one to five years. The interest rate resets at that point and might continue to reset periodically until the loan has been fully repaid. The incentive is a very low-interest rate at the beginning, compared to the fixed-rate mortgage rate. The downside is the potential for a substantially higher rate down the road. Business Loan It is usually easier for a business to secure a balloon loan if the business has a proven financial history and favorable credit record. An established business can be in a better position than an individual wage-earner to raise sufficient money to pay off the balloon payment. For this reason, lenders often consider businesses less risky than individual consumers for business loans. Balloon payments can be strategically used by a business to finance short-term needs. The business may draw on a balloon loan with no intention of holding the debt to the end of the term. Instead, the company can use the money to repay the loan in full before the end of the loan term. Options for Avoiding a Balloon Payment A borrower has a couple of ways to get rid of a looming payment. In addition to extinguishing the debt by paying off the balloon payment, a borrower can: Refinance the loan. A lender may be willing to work with a borrower to repurpose the debt into a different loan vehicle or modify the terms of the original agreement. Sell the underlying asset. If the balloon payment is due to the purchase of an asset, a borrower may be forced to liquidate the holding to avoid defaulting on the loan. Pay principal upfront. Though not required, a borrower may be able to pay a portion of the debt early. Any payment made more than the interest assessment will be applied to the principal balance. Check with your lender to ensure there are no prepayment penalties or fees. Negotiate an extension. Similar to refinancing, an extension changes the terms of the prior loan. However, instead of receiving a new deal, an extension will simply push out the timing of the balloon payment. You'll likely have the same payment terms as before but with different obligation dates. Balloon loans usually require collateral. For home or car loans, the lender may require a lien on the property being purchased. Should you default on your loan and not be able to satisfy the balloon payment, the lender has a legal claim to seize the property. Advantages of Balloon Payments The obvious advantage of balloon payments is the low initial payment requirement. The monthly balloon payment amount during the fixed period is generally less than the payment amount of a fully amortized loan. The timing of the payment size may mesh well with the borrower's income expectations. As the borrower's salary increases due to career progression, the debt obligation will rise as well. A balloon note or loan often has a shorter underwriting process compared to other loans. For this reason, there may be lower administrative or transaction fees in securing the loan. A borrower may also not be required to show as much documentation for this type of loan, as balloon mortgages often do not require a home appraisal as part of loan closing. A balloon payment structure is strategically advantageous for some borrowers. For example, people who flip houses can secure lower upfront monthly payments. The borrower has time to remodel the house and sell it before the balloon payment is due. This allows borrowers to preserve future cash flow for other purposes. Disadvantages of Balloon Payments Balloon payments can be a big problem in a falling housing market. As home prices decline, homeowners may be unable to sell their homes for enough to cover the balloon payment, and they might be unable to sell at any price. For home flippers, this means getting stuck with a high-interest rate loan should sales stall. Borrowers often have no choice but to default on their loans and enter foreclosure, regardless of their household incomes, when faced with a balloon payment they cannot afford. This results in the loss of the borrower's home. Some will be able to take out another loan to cover the upcoming balloon mortgage payment, but this puts a tremendous strain on a family's finances. Balloon mortgages and auto loans may be difficult to refinance depending on the amount of equity that has been paid off. The loans may only pay interest early on. In this case, the owner may have little-to-no equity in the property despite making consistent payments for years. These types of loans can be harder to qualify for. Because principal payments are deferred, lenders often prefer borrowers with a high credit score or high down payment. In addition, to compensate for the flexibility of the principal obligation and increased risk for the lender, lenders usually charge higher interest rates for balloon debt compared to other types of loans. What Is a Balloon Payment? A balloon payment is a lump sum principal balance that is due at the end of a loan term. The borrower pays much smaller monthly payments until the balloon payment is due. These payments may be entirely or almost entirely interest on the loan rather than principal. Borrowers are assuming that they can refinance the mortgage or sell the home at a profit before the balloon payment falls due. If the housing market takes an unexpected downturn and their home loses value, that strategy may fail.
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Answer in a full sentence, no less than 50 words, and cite the part of the text that supports your statement.
EVIDENCE:
**Balloon Payment: What It Is, How It Works** A balloon payment is the final amount due on a loan that is structured as a series of small monthly payments followed by a single much larger sum at the end of the loan period. The early payments may be all or almost all payments of interest owed on the loan, with the balloon payment being the principal of the loan. This type of loan is known as a balloon loan. The balloon home mortgage loan became common in the years before the 2007-2008 financial crisis. It allowed people eager to buy a home to obtain a mortgage payment that they could afford, at least in the early years. The balloon loan did not disappear with the financial crisis but is now more often used for business loans. A project can be financed with a loan that allows for minimal payments early on, with the balloon payment due only when the project is earning a return on the investment. A balloon payment is a type of loan structured so that the last payment is far larger than prior payments. Balloon payments are an option for home mortgages, auto loans, and business loans. Borrowers have lower initial monthly payments under a balloon loan. The interest rate is usually higher for a balloon loan, and only borrowers with high creditworthiness are considered. The balloon payment may be a weighted payment amount or, under an interest-only payment plan, be the full balance of the principal due. Understanding Balloon Payments As the term "balloon" suggests, the final payment on this type of loan is significantly large. In recent years, balloon payments have been more common in commercial lending than in consumer lending. It allows a commercial lender to keep short-term costs lower and take care of the balloon payment with future earnings. The same logic is used by individual homebuyers, but the risks are greater. Homebuyers are keeping their short-term costs low while assuming that their incomes will be far greater when the balloon payment comes due, that they will be able to refinance their mortgage before it is due, or that they can sell the house and pay off the entire mortgage before the balloon payment comes due. That strategy failed in the 2008-2009 financial crisis, when homeowners who financed their purchases with balloon mortgages found it impossible to sell their homes at a price high enough to pay off the amount they had borrowed. Balloon payments are often packaged into two-step mortgages. In this financing structure, a borrower receives an introductory and often lower interest rate at the start of their loan. Then, the loan shifts to a higher interest rate after an initial borrowing period. Balloon Payment Examples A balloon debt structure can be implemented for any type of debt. It's most commonly used in mortgages, auto loans, and business loans. Mortgage The balloon mortgage is rarely used for traditional 15-year or 30-year mortgages since lenders don't want to wait that long to get their money back. For balloon mortgages, lenders prefer a five-year to ten-year term. Interest-only balloon mortgages are available primarily to high-net-worth individuals who can afford large down payments. They are often taken with the intention of refinancing before the balloon payment is due. Balloon Loan vs. ARM A balloon loan is sometimes confused with an adjustable-rate mortgage (ARM). With an ARM, the borrower receives an introductory rate for a set amount of time, usually for one to five years. The interest rate resets at that point and might continue to reset periodically until the loan has been fully repaid. The incentive is a very low-interest rate at the beginning, compared to the fixed-rate mortgage rate. The downside is the potential for a substantially higher rate down the road. Business Loan It is usually easier for a business to secure a balloon loan if the business has a proven financial history and favorable credit record. An established business can be in a better position than an individual wage-earner to raise sufficient money to pay off the balloon payment. For this reason, lenders often consider businesses less risky than individual consumers for business loans. Balloon payments can be strategically used by a business to finance short-term needs. The business may draw on a balloon loan with no intention of holding the debt to the end of the term. Instead, the company can use the money to repay the loan in full before the end of the loan term. Options for Avoiding a Balloon Payment A borrower has a couple of ways to get rid of a looming payment. In addition to extinguishing the debt by paying off the balloon payment, a borrower can: Refinance the loan. A lender may be willing to work with a borrower to repurpose the debt into a different loan vehicle or modify the terms of the original agreement. Sell the underlying asset. If the balloon payment is due to the purchase of an asset, a borrower may be forced to liquidate the holding to avoid defaulting on the loan. Pay principal upfront. Though not required, a borrower may be able to pay a portion of the debt early. Any payment made more than the interest assessment will be applied to the principal balance. Check with your lender to ensure there are no prepayment penalties or fees. Negotiate an extension. Similar to refinancing, an extension changes the terms of the prior loan. However, instead of receiving a new deal, an extension will simply push out the timing of the balloon payment. You'll likely have the same payment terms as before but with different obligation dates. Balloon loans usually require collateral. For home or car loans, the lender may require a lien on the property being purchased. Should you default on your loan and not be able to satisfy the balloon payment, the lender has a legal claim to seize the property. Advantages of Balloon Payments The obvious advantage of balloon payments is the low initial payment requirement. The monthly balloon payment amount during the fixed period is generally less than the payment amount of a fully amortized loan. The timing of the payment size may mesh well with the borrower's income expectations. As the borrower's salary increases due to career progression, the debt obligation will rise as well. A balloon note or loan often has a shorter underwriting process compared to other loans. For this reason, there may be lower administrative or transaction fees in securing the loan. A borrower may also not be required to show as much documentation for this type of loan, as balloon mortgages often do not require a home appraisal as part of loan closing. A balloon payment structure is strategically advantageous for some borrowers. For example, people who flip houses can secure lower upfront monthly payments. The borrower has time to remodel the house and sell it before the balloon payment is due. This allows borrowers to preserve future cash flow for other purposes. Disadvantages of Balloon Payments Balloon payments can be a big problem in a falling housing market. As home prices decline, homeowners may be unable to sell their homes for enough to cover the balloon payment, and they might be unable to sell at any price. For home flippers, this means getting stuck with a high-interest rate loan should sales stall. Borrowers often have no choice but to default on their loans and enter foreclosure, regardless of their household incomes, when faced with a balloon payment they cannot afford. This results in the loss of the borrower's home. Some will be able to take out another loan to cover the upcoming balloon mortgage payment, but this puts a tremendous strain on a family's finances. Balloon mortgages and auto loans may be difficult to refinance depending on the amount of equity that has been paid off. The loans may only pay interest early on. In this case, the owner may have little-to-no equity in the property despite making consistent payments for years. These types of loans can be harder to qualify for. Because principal payments are deferred, lenders often prefer borrowers with a high credit score or high down payment. In addition, to compensate for the flexibility of the principal obligation and increased risk for the lender, lenders usually charge higher interest rates for balloon debt compared to other types of loans. What Is a Balloon Payment? A balloon payment is a lump sum principal balance that is due at the end of a loan term. The borrower pays much smaller monthly payments until the balloon payment is due. These payments may be entirely or almost entirely interest on the loan rather than principal. Borrowers are assuming that they can refinance the mortgage or sell the home at a profit before the balloon payment falls due. If the housing market takes an unexpected downturn and their home loses value, that strategy may fail.
USER:
According to this article, what are the advantages of a Balloon Loan?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 21 | 12 | 1,484 | null | 62 |
Answer the following question using only the information provided in the prompt. Do not use any external resources to formulate your answer.
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What are the advantages of using Wi-Fi or cellular networks to send EEWs compared to FEMA communication pathways?
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According to the 2023 USGS National Seismic Hazard Model (NSHM), nearly 75% of the area of the conterminous United States, Alaska, and Hawaii could experience damaging earthquake shaking. According to the USGS, the congressionally requested NSHM update utilized the latest techniques and technologies and incorporated more data to identify nearly 500 additional faults in the United States. The USGS considers the NSHM an essential tool to help engineers and others mitigate the impact of earthquake hazards on people and property. The NSHM will benefit the USGS-led ShakeAlert, an earthquake early warning (EEW) system operating in California, Oregon, and Washington by providing more information about faults and potential shaking intensity. People and automated systems receive an EEW before potential strong ground shaking reaches their locations after detecting an earthquake. Upon receiving the alerts, people can protect themselves and automated systems can protect property from the impending shaking. EEW is among the most challenging types of emergency communications, in part because earthquakes cannot be predicted and occur suddenly. In addition, mass notification to high-risk areas must occur within seconds of earthquake detection to be effective. In 2021, EEWs sent via the Federal Emergency Management Agency (FEMA) communication pathways often did not arrive before intense shaking occurred. EEWs sent in 2021 via cell phone applications over Wi-Fi or cellular networks were typically faster, and most alerts arrived before intense shaking occurred. Congress may be interested in how to improve emergency communications, especially for mass notifications, using FEMA communication pathways or the First Responder Network so that alerts arrive before the shaking occurs.
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System Instructions: Answer the following question using only the information provided in the context block. Do not use any external resources to formulate your answer. Question: What are the advantages of using Wi-Fi or cellular networks to send EEWs compared to FEMA communication pathways? Context Block: According to the 2023 USGS National Seismic Hazard Model (NSHM), nearly 75% of the area of the conterminous United States, Alaska, and Hawaii could experience damaging earthquake shaking. According to the USGS, the congressionally requested NSHM update utilized the latest techniques and technologies and incorporated more data to identify nearly 500 additional faults in the United States. The USGS considers the NSHM an essential tool to help engineers and others mitigate the impact of earthquake hazards on people and property. The NSHM will benefit the USGS-led ShakeAlert, an earthquake early warning (EEW) system operating in California, Oregon, and Washington by providing more information about faults and potential shaking intensity. People and automated systems receive an EEW before potential strong ground shaking reaches their locations after detecting an earthquake. Upon receiving the alerts, people can protect themselves and automated systems can protect property from the impending shaking. EEW is among the most challenging types of emergency communications, in part because earthquakes cannot be predicted and occur suddenly. In addition, mass notification to high-risk areas must occur within seconds of earthquake detection to be effective. In 2021, EEWs sent via the Federal Emergency Management Agency (FEMA) communication pathways often did not arrive before intense shaking occurred. EEWs sent in 2021 via cell phone applications over Wi-Fi or cellular networks were typically faster, and most alerts arrived before intense shaking occurred. Congress may be interested in how to improve emergency communications, especially for mass notifications, using FEMA communication pathways or the First Responder Network so that alerts arrive before the shaking occurs.
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Answer the following question using only the information provided in the prompt. Do not use any external resources to formulate your answer.
EVIDENCE:
According to the 2023 USGS National Seismic Hazard Model (NSHM), nearly 75% of the area of the conterminous United States, Alaska, and Hawaii could experience damaging earthquake shaking. According to the USGS, the congressionally requested NSHM update utilized the latest techniques and technologies and incorporated more data to identify nearly 500 additional faults in the United States. The USGS considers the NSHM an essential tool to help engineers and others mitigate the impact of earthquake hazards on people and property. The NSHM will benefit the USGS-led ShakeAlert, an earthquake early warning (EEW) system operating in California, Oregon, and Washington by providing more information about faults and potential shaking intensity. People and automated systems receive an EEW before potential strong ground shaking reaches their locations after detecting an earthquake. Upon receiving the alerts, people can protect themselves and automated systems can protect property from the impending shaking. EEW is among the most challenging types of emergency communications, in part because earthquakes cannot be predicted and occur suddenly. In addition, mass notification to high-risk areas must occur within seconds of earthquake detection to be effective. In 2021, EEWs sent via the Federal Emergency Management Agency (FEMA) communication pathways often did not arrive before intense shaking occurred. EEWs sent in 2021 via cell phone applications over Wi-Fi or cellular networks were typically faster, and most alerts arrived before intense shaking occurred. Congress may be interested in how to improve emergency communications, especially for mass notifications, using FEMA communication pathways or the First Responder Network so that alerts arrive before the shaking occurs.
USER:
What are the advantages of using Wi-Fi or cellular networks to send EEWs compared to FEMA communication pathways?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 18 | 259 | null | 853 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
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What are medications used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD)? In a bulleted format, please also review these medications in further detail such as mechanism of action and risks.
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Treatment Before starting treatment, it is important to identify the target outcomes to guide the therapy decision. Drug treatment should be based on a thorough assessment and should always be part of a comprehensive treatment plan that includes psychosocial, behavioural, and educational advice and interventions. Psychotherapy combined with medication may play a role in treating behavioural problems, organisational issues and psychiatric comorbidities [57]. In Italy, an ADHD diagnosis can only be made at a regional referral centre approved by the Italian Ministry of Health. Treatment guidelines put forward by the Ministry of Health and based on European guidelines, specify that pharmacological treatment can only be initiated after failure of cognitive behavioural therapy over a period of 6 months or longer has been demonstrated. Patients must first be enrolled in the ADHD medication registry before treatment with MPH or atomoxetine (ATX) can be prescribed. Behavioural therapy and pharmacological treatment have both been shown to benefit ADHD patients. A longitudinal study of the efficacy of different treatments (an intensively monitored medication program, behavioural therapy, combination of medication and behavioural therapy or treatment as usual by community care) showed after 8-year follow-up that all four of the original treatment groups had a similar outcome: all showed improvement in comparison with pretreatment baseline scores, but none demonstrated superiority [58]. The fronto-subcortical circuits (lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and putamen) associated with ADHD are rich in catecholamines, which are involved in the mechanism of action of medications used to treat this disorder. Neuropharmacological studies have provided evidence that ADHD involves dysregulation of both noradrenaline (NE) and DA neurotransmitter systems [59]. MPH treatment causes an increase in DA signalling through multiple actions, including blockade of the DA reuptake transporter, amplification of DA response duration, disinhibition of the dopamine D2 receptor and amplification of DA tone [60]. MPH is also an inhibitor of NE re-uptake. ATX is a selective inhibitor of synaptic re-uptake, and in vivo, it specifically increases extracellular levels of DA in the prefrontal cortex but not in the striatum; probably by modulating cortical synaptic DA uptake via the NE transporter [61]. Dextroamphetamine increases the synaptic activity of DA and NE by increasing the release of the neurotransmitters into the synaptic cleft, decreasing reuptake back into the presynaptic neuron, and inhibiting their catabolism [62]. Strong evidence exists indicating that stimulant medications, such as MPH and dextroamphetamine, and the non-stimulant ATX, are effective in improving ADHD symptoms [63]. Guanfacine is a selective alpha2A adrenergic receptor agonist, which improves working memory by stimulating postsynaptic alpha2A adrenoceptors, strengthening the functional connectivity of prefrontal cortex networks [64]. Guanfacine has also been shown to be effective in reducing ADHD symptoms [65, 66]. Table 1 summarises the most important characteristics of these pharmacological treatments for ADHD. Only ATX and immediate release MPH are currently approved for the treatment of ADHD in Italy. Table 1 Clinical characteristics of ADHD pharmacotherapies Full size table ADHD pharmacological therapies are generally well-tolerated (Table 1). However, concerns surrounding the cardiovascular safety of some of these drugs has prompted a recent examination of the effects of ATX and MPH on blood pressure (BP), heart rate (HR), and ECG parameters. MPH appears to cause minor increases in BP and HR, with no strong data to suggest that itincreases the QT interval. Limited data suggest that ATX may increase BP and HR in the short term; in the long term it appears to only increase BP. The effects of ATX on QT interval remain uncertain. Because the current evidence is based on research that has not been specifically designed to investigate the cardiovascular effects of these drugs, it is difficult to draw firm conclusions [67]. Both MPH and ATX significantly increase activation in key cortical and subcortical regions subserving attention and executive functions. Therefore, alterations in dopaminergic and noradrenergic function are apparently necessary for the clinical efficacy of pharmacological treatment of ADHD [68]. However MPH and ATX have both common and distinct neural effects, consistent with the observation that while many children respond well to both treatments, some respond preferentially to one or the other. Although pharmacotherapy for ADHD appears to prepare and facilitate the brain for learning, experiential programs need to elicit compensatory development in the brain. The clinical amelioration of some children after environmental experiential inputs and early cognitive/behavioural treatment could indicate outcome-associated plastic brain response [69]. One year of treatment with MPH may be beneficial to show enduring normalisation of neural correlates of attention. However, little is known about the long-term effects of stimulants on the functional organisation of the developing brain [70]. Recent findings have shown that chronic MPH use in drug-naive boys with ADHD enhanced neuropsychological functioning on "recognition memory" component tasks with modest executive demands [71]. Patients receiving pharmacological treatment for ADHD should always be closely monitored for both common and unusual potentially severe adverse effects.
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What are medications used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD)? In a bulleted format, please also review these medications in further detail such as mechanism of action and risks. Treatment Before starting treatment, it is important to identify the target outcomes to guide the therapy decision. Drug treatment should be based on a thorough assessment and should always be part of a comprehensive treatment plan that includes psychosocial, behavioural, and educational advice and interventions. Psychotherapy combined with medication may play a role in treating behavioural problems, organisational issues and psychiatric comorbidities [57]. In Italy, an ADHD diagnosis can only be made at a regional referral centre approved by the Italian Ministry of Health. Treatment guidelines put forward by the Ministry of Health and based on European guidelines, specify that pharmacological treatment can only be initiated after failure of cognitive behavioural therapy over a period of 6 months or longer has been demonstrated. Patients must first be enrolled in the ADHD medication registry before treatment with MPH or atomoxetine (ATX) can be prescribed. Behavioural therapy and pharmacological treatment have both been shown to benefit ADHD patients. A longitudinal study of the efficacy of different treatments (an intensively monitored medication program, behavioural therapy, combination of medication and behavioural therapy or treatment as usual by community care) showed after 8-year follow-up that all four of the original treatment groups had a similar outcome: all showed improvement in comparison with pretreatment baseline scores, but none demonstrated superiority [58]. The fronto-subcortical circuits (lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and putamen) associated with ADHD are rich in catecholamines, which are involved in the mechanism of action of medications used to treat this disorder. Neuropharmacological studies have provided evidence that ADHD involves dysregulation of both noradrenaline (NE) and DA neurotransmitter systems [59]. MPH treatment causes an increase in DA signalling through multiple actions, including blockade of the DA reuptake transporter, amplification of DA response duration, disinhibition of the dopamine D2 receptor and amplification of DA tone [60]. MPH is also an inhibitor of NE re-uptake. ATX is a selective inhibitor of synaptic re-uptake, and in vivo, it specifically increases extracellular levels of DA in the prefrontal cortex but not in the striatum; probably by modulating cortical synaptic DA uptake via the NE transporter [61]. Dextroamphetamine increases the synaptic activity of DA and NE by increasing the release of the neurotransmitters into the synaptic cleft, decreasing reuptake back into the presynaptic neuron, and inhibiting their catabolism [62]. Strong evidence exists indicating that stimulant medications, such as MPH and dextroamphetamine, and the non-stimulant ATX, are effective in improving ADHD symptoms [63]. Guanfacine is a selective alpha2A adrenergic receptor agonist, which improves working memory by stimulating postsynaptic alpha2A adrenoceptors, strengthening the functional connectivity of prefrontal cortex networks [64]. Guanfacine has also been shown to be effective in reducing ADHD symptoms [65, 66]. Table 1 summarises the most important characteristics of these pharmacological treatments for ADHD. Only ATX and immediate release MPH are currently approved for the treatment of ADHD in Italy. Table 1 Clinical characteristics of ADHD pharmacotherapies Full size table ADHD pharmacological therapies are generally well-tolerated (Table 1). However, concerns surrounding the cardiovascular safety of some of these drugs has prompted a recent examination of the effects of ATX and MPH on blood pressure (BP), heart rate (HR), and ECG parameters. MPH appears to cause minor increases in BP and HR, with no strong data to suggest that itincreases the QT interval. Limited data suggest that ATX may increase BP and HR in the short term; in the long term it appears to only increase BP. The effects of ATX on QT interval remain uncertain. Because the current evidence is based on research that has not been specifically designed to investigate the cardiovascular effects of these drugs, it is difficult to draw firm conclusions [67]. Both MPH and ATX significantly increase activation in key cortical and subcortical regions subserving attention and executive functions. Therefore, alterations in dopaminergic and noradrenergic function are apparently necessary for the clinical efficacy of pharmacological treatment of ADHD [68]. However MPH and ATX have both common and distinct neural effects, consistent with the observation that while many children respond well to both treatments, some respond preferentially to one or the other. Although pharmacotherapy for ADHD appears to prepare and facilitate the brain for learning, experiential programs need to elicit compensatory development in the brain. The clinical amelioration of some children after environmental experiential inputs and early cognitive/behavioural treatment could indicate outcome-associated plastic brain response [69]. One year of treatment with MPH may be beneficial to show enduring normalisation of neural correlates of attention. However, little is known about the long-term effects of stimulants on the functional organisation of the developing brain [70]. Recent findings have shown that chronic MPH use in drug-naive boys with ADHD enhanced neuropsychological functioning on "recognition memory" component tasks with modest executive demands [71]. Patients receiving pharmacological treatment for ADHD should always be closely monitored for both common and unusual potentially severe adverse effects. https://link.springer.com/article/10.1186/1824-7288-36-79
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
Treatment Before starting treatment, it is important to identify the target outcomes to guide the therapy decision. Drug treatment should be based on a thorough assessment and should always be part of a comprehensive treatment plan that includes psychosocial, behavioural, and educational advice and interventions. Psychotherapy combined with medication may play a role in treating behavioural problems, organisational issues and psychiatric comorbidities [57]. In Italy, an ADHD diagnosis can only be made at a regional referral centre approved by the Italian Ministry of Health. Treatment guidelines put forward by the Ministry of Health and based on European guidelines, specify that pharmacological treatment can only be initiated after failure of cognitive behavioural therapy over a period of 6 months or longer has been demonstrated. Patients must first be enrolled in the ADHD medication registry before treatment with MPH or atomoxetine (ATX) can be prescribed. Behavioural therapy and pharmacological treatment have both been shown to benefit ADHD patients. A longitudinal study of the efficacy of different treatments (an intensively monitored medication program, behavioural therapy, combination of medication and behavioural therapy or treatment as usual by community care) showed after 8-year follow-up that all four of the original treatment groups had a similar outcome: all showed improvement in comparison with pretreatment baseline scores, but none demonstrated superiority [58]. The fronto-subcortical circuits (lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and putamen) associated with ADHD are rich in catecholamines, which are involved in the mechanism of action of medications used to treat this disorder. Neuropharmacological studies have provided evidence that ADHD involves dysregulation of both noradrenaline (NE) and DA neurotransmitter systems [59]. MPH treatment causes an increase in DA signalling through multiple actions, including blockade of the DA reuptake transporter, amplification of DA response duration, disinhibition of the dopamine D2 receptor and amplification of DA tone [60]. MPH is also an inhibitor of NE re-uptake. ATX is a selective inhibitor of synaptic re-uptake, and in vivo, it specifically increases extracellular levels of DA in the prefrontal cortex but not in the striatum; probably by modulating cortical synaptic DA uptake via the NE transporter [61]. Dextroamphetamine increases the synaptic activity of DA and NE by increasing the release of the neurotransmitters into the synaptic cleft, decreasing reuptake back into the presynaptic neuron, and inhibiting their catabolism [62]. Strong evidence exists indicating that stimulant medications, such as MPH and dextroamphetamine, and the non-stimulant ATX, are effective in improving ADHD symptoms [63]. Guanfacine is a selective alpha2A adrenergic receptor agonist, which improves working memory by stimulating postsynaptic alpha2A adrenoceptors, strengthening the functional connectivity of prefrontal cortex networks [64]. Guanfacine has also been shown to be effective in reducing ADHD symptoms [65, 66]. Table 1 summarises the most important characteristics of these pharmacological treatments for ADHD. Only ATX and immediate release MPH are currently approved for the treatment of ADHD in Italy. Table 1 Clinical characteristics of ADHD pharmacotherapies Full size table ADHD pharmacological therapies are generally well-tolerated (Table 1). However, concerns surrounding the cardiovascular safety of some of these drugs has prompted a recent examination of the effects of ATX and MPH on blood pressure (BP), heart rate (HR), and ECG parameters. MPH appears to cause minor increases in BP and HR, with no strong data to suggest that itincreases the QT interval. Limited data suggest that ATX may increase BP and HR in the short term; in the long term it appears to only increase BP. The effects of ATX on QT interval remain uncertain. Because the current evidence is based on research that has not been specifically designed to investigate the cardiovascular effects of these drugs, it is difficult to draw firm conclusions [67]. Both MPH and ATX significantly increase activation in key cortical and subcortical regions subserving attention and executive functions. Therefore, alterations in dopaminergic and noradrenergic function are apparently necessary for the clinical efficacy of pharmacological treatment of ADHD [68]. However MPH and ATX have both common and distinct neural effects, consistent with the observation that while many children respond well to both treatments, some respond preferentially to one or the other. Although pharmacotherapy for ADHD appears to prepare and facilitate the brain for learning, experiential programs need to elicit compensatory development in the brain. The clinical amelioration of some children after environmental experiential inputs and early cognitive/behavioural treatment could indicate outcome-associated plastic brain response [69]. One year of treatment with MPH may be beneficial to show enduring normalisation of neural correlates of attention. However, little is known about the long-term effects of stimulants on the functional organisation of the developing brain [70]. Recent findings have shown that chronic MPH use in drug-naive boys with ADHD enhanced neuropsychological functioning on "recognition memory" component tasks with modest executive demands [71]. Patients receiving pharmacological treatment for ADHD should always be closely monitored for both common and unusual potentially severe adverse effects.
USER:
What are medications used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD)? In a bulleted format, please also review these medications in further detail such as mechanism of action and risks.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 32 | 806 | null | 50 |
Answer the following question using only details found in the attached paper. You should NOT reference outside sources or your own knowledge.
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What are some examples of visible and hidden biases that have been observed in criminal justice AI?
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Executive Summary ‘Artificial Intelligence’ (‘AI’), comprising machine-learning and other analytical algorithm-based automated systems, has become an important aspect of our lives. In recent years, this technology has been increasingly deployed in criminal justice systems across the world, playing an increasingly significant role in the administration of justice in criminal cases. This trend is often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost savings in policing and court services. However, studies in various jurisdictions, including in Europe, provide substantial evidence that AI and machine-learning systems can have a significantly negative influence on criminal justice. AI systems have been shown to directly generate and reinforce discriminatory and unjust outcomes; infringing fundamental rights, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design that does not comply with human rights standards. Most AI systems used in criminal justice systems are statistical models, based on data which is representative of structural biases and inequalities in the societies which the data represents, and which is always comprehensively lacking in the kind of detail that is needed to make truly ‘accurate’ predictions or decisions. The data used to build and populate these systems is mostly or entirely from within criminal justice systems, such as law enforcement or crime records. This data does not represent an accurate record of criminality, but merely a record of law enforcement - the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data reflects social inequalities and discriminatory policing patterns, and its use in these AI systems merely results in a reinforcement and re-entrenchment of those inequalities and discrimination in criminal justice outcomes. Given these extremely serious risks, strong regulatory frameworks are needed to govern the use of AI in criminal justice decision-making and, in some circumstances, to restrict its use entirely. Existing EU data protection laws restrict the use of automated decisions, but there are gaps and ambiguities that could result in the use of AI systems in ways that undermine human rights, if not accompanied by further guidance or legislation. Firstly, EU laws currently only prohibit decisions that are solely based on automated processes, but they do not regulate decision-making processes that are largely dependent on automated systems. Given that most AI systems in use today are designed and deployed to assist, rather than replace, human decision-making in criminal justice systems, they largely fall outside the remit of EU data protection laws on automated decisions. Secondly, the prohibition on automated decisions is subject to broad exceptions. Individuals can be subject to decisions based solely on automated processes if authorised by EU or Member State law, and there are deemed to be appropriate human rights safeguards in place, including the right to obtain human intervention. However, there is not enough clarity on what safeguards are needed, and how ‘human intervention’ should be interpreted. In order to regulate the use of AI in criminal justice proceedings, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. The design of AI systems and their deployment in criminal justice proceedings should be regulated to generate human rights compliant, non-discriminatory outcomes. Minimum standards and safeguards should be set, which, if they cannot be adhered to, should preclude the use of the AI system in question. AI should also be regulated so that they are sufficiently transparent and explainable to enable effective independent scrutiny. AI systems should be designed and deployed to comply with and give effect to inter alia the right of access to court, the right to be presumed innocent, and the right to liberty. AI systems should not undermine the right to be tried by an impartial and independent tribunal and, in line with existing EU laws, no individual should be subject to an automated decision that results in a criminal record. AI systems should be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure that they have the desired effect of reducing pre-trial detention rates. AI systems must be developed to guarantee that they do not generate discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race, ethnicity, nationality or socioeconomic background. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. AI systems which cannot adhere to this minimum standard should have no place in the criminal justice system. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, and the general public. Commercial or proprietary interests should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decisions made against them. It should be possible to carry out an independent audit of each AI system, and its processes should be reproducible for that purpose. Member States should have laws that govern how AI systems are relied upon in criminal proceedings, and there must be adequate safeguards to prevent over-reliance on AI by decision-makers, to prevent discrimination and to ensure scrutiny and effective challenge by the defence. Procedural safeguards should actively tackle automation-bias amongst criminal justice decision makers. Examples include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easy for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. Criminal justice procedures should ensure that defendants are notified if an AI system has been used which has or may have influenced a decision taken about them at any point in the criminal justice system, from investigation to arrest, from charge to conviction, and sentence. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is clear and comprehensible to a layperson, without the need for technical or expert assistance, in order to ensure fairness, equality of arms, and to discharge the obligations to provide all relevant information and be given reasons for decisions under the right to a fair trial. Suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training should be made available to all primary users of AI systems, and to criminal defence practitioners, so that there is greater awareness of AI technology, and of the risks of over-reliance on AI. Effective regulation of AI systems should be facilitated by a governance and monitoring framework. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. A requirement of the assessment should be a consideration of whether it is necessary to use AI in the particular use case, or whether an alternative solution could achieve the same aims. As far as it is possible to do so, AI systems should also be tested for impact pre-deployment, a part of which should be the minimum requirement to prove that the AI system has no discriminatory impact, either directly or indirectly, before it can be deployed. AI systems should be kept under regular review post-deployment. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity. Background Rapid technological advancements in recent years have made artificial intelligence (‘AI’) an increasingly prominent aspect of our lives. There are differences of opinion as to the definition of AI and its true meaning, but for the purposes of this paper we are broadly referring to automated decision-making systems based on algorithms, including machine-learning, which are used in the criminal justice system. There is little doubt that AI has great capacity to increase human potential and improve the lives of many, but the increasing role of AI in assisting important public functions has also highlighted serious risks and challenges. If not subject to proper regulation and oversight, AI can threaten fundamental human rights and, far from expanding human potential, it can amplify and worsen harmful aspects of our society, including inequality and injustice. This challenge is particularly evident where AI has been used to assist the administration of justice in criminal cases. In recent years, more and more jurisdictions across the world have begun to use AI technology to inform and assist policing and judicial decisions, often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost-savings in policing and court services. In some countries, algorithmic processes can influence which geographic neighbourhoods should be subject to increased law enforcement and when, as well as which individuals should be specifically targeted by law enforcement. They can help to determine whether someone should be arrested, whether they should be charged with a criminal offence, whether they should be detained in prison before trial and, if convicted and sentenced, the length of their sentence. AI is being used more and more to influence highly sensitive, high impact decisions that have far reaching, long-term implications for individuals’ rights. Research emerging from the United States, where the use of AI in criminal justice is particularly widespread, and from the United Kingdom and some EU Member States, however, seriously questions whether AI has a positive influence on criminal justice systems. AI tools and systems have been found to actively generate discriminatory criminal justice outcomes, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design, that does not reflect or give effect to human rights standards. These criticisms might not be justified for all AI systems, but these studies highlight the need for much stronger regulatory frameworks to govern the use of AI. We believe that unless it is subject to robust regulation, it is unlikely that AI can be used in criminal justice systems without undermining the right to a fair trial. In some cases, it should be restricted from use entirely. EU Member States should be encouraged to take a much more cautious approach to AI and subject automated processes to more stringent rules that are designed to ensure human rights compliance. There is the potential for AI systems, if properly and robustly regulated, to have a positive impact on criminal justice system, advancing human rights, for example, by analysing law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination. The EU is already a world leader on AI regulation, having adopted ground-breaking data protection laws in recent years to shield individuals from automated decisions that have an adverse effect on their rights. We welcome the EU’s commitment to build further on existing legal standards, and we emphasise that addressing the impact of AI on criminal justice has to be a primary consideration for EU policy makers when deciding on appropriate legal standards. Discussions around the impact of AI on human rights have largely been centred on data protection, the right to privacy, and broader questions of ethics and human dignity. However, despite the increasing use of AI systems in criminal justice systems across the world, only limited discussions have so far focused on how these systems impact the right to a fair trial, and what regulations are needed to address that impact. About this paper Fair Trials has produced this policy paper to highlight the need for EU-wide standards on the regulation of AI in criminal justice, and to inform EU policy makers about the standards and safeguards needed to ensure effective protection of fair trial rights where criminal justice decisions are assisted by AI. The EU Commission recognised that AI represents risks for fundamental rights, including the right to a fair trial, in its 2020 White Paper, ‘On Artificial Intelligence – A European approach to excellence and trust’. It also recognised the need for improvements to the EU’s legislative framework on AI, noting in particular the challenges in the ‘effective application and enforcement of existing EU and national legislation’ and the ‘limitations of scope of existing EU legislation’. In this paper, we identify the most common fair trial rights issues raised by existing AI systems, based on examples and experiences from the EU, the United Kingdom, and the United States. We also offer examples of practical legal and policy solutions that could help to address these challenges, and to assist in the effective implementation of the EU’s fundamental rights standards in this area. We recognise that the use of AI has a broader impact on human rights beyond the right to a fair trial, and that there are important social and ethical issues that also need to be addressed. However, we have narrowed the focus of this paper given Fair Trials’ mission and field of expertise. This paper should not be treated as an exhaustive list of fair trial rights standards that need to be introduced. AI is used in many ways in criminal justice systems cross the world and, as the technology continues to develop, it is likely that we will eventually see the deployment of AI technology in ways never imagined before. This paper focuses primarily on AI systems that carry out individualised risk assessments, given that these types of systems have had the most significant impact on individuals’ rights so far, and we envisage that similar systems will become increasingly common in the near future. Existing EU Legal Framework Existing EU laws restrict the use of automated decisions in a wide variety of contexts. Article 22 of the General Data Protection Regulation (‘GDPR’) provides that data subjects have the right not to be subject to decisions ‘solely’ based on automated processes, where they produce ‘legal effects’ concerning them, or where they ‘similarly significantly affect’ them. The Law Enforcement Directive (‘LED’) – the EU data legislation that governs the processing of data for criminal justice purposes – has a very similar provision at Article 11, which requires Member States to prohibit decisions based solely on automated processing, where they produce ‘adverse legal effects’ on the individual, or effects that are ‘similarly significant’. However, there are two notable gaps in the existing legislative framework governing automated decision-making systems under both the GDPR and the LED. These ambiguities and potential loopholes could be exploited in ways that seriously undermine the general prohibition of automated decision-making processes, and adversely impact human rights. It is necessary, therefore, that the EU provides further guidance on how these provisions should be interpreted, including thorough legislation (if appropriate) to further clarify the circumstances in which Member States are allowed to deploy AI systems for criminal justice proceedings. Firstly, the provisions in the GDPR and LED only prohibit decisions based ‘solely’ on automated processes. In other words, the laws regulate the impact of decisions made through automated processing, but not the AI systems themselves. As discussed later in this paper, the main human rights challenges of AI systems can be attributed to how they are designed and trained, and the types of technology used, such as machine-learning, so it is crucial that decisions about the design and deployment of AI systems are also regulated. Secondly, neither the GDPR or LED provide regulatory standards to govern situations where automated processing is not the ‘sole’ basis of a decision, but a primary influencer. In reality, the difference between a fully automated decision and a decision made with a ‘human-in-the-loop’ is not always clear, but because of this strict classification, AI systems are able to be used and have significant legal effects without the corresponding safeguards. Stronger legal standards are needed to make sure that semi-automated decision-making processes do not become de facto automated processes. Thirdly, the prohibition on automated decision-making is subject to two very broad exceptions. Automated decisions are prohibited under the GDPR and LED, ‘unless authorised by Union or Member State law’ and there need to be ‘appropriate safeguards for the rights and freedoms of the data subject, at least the right to obtain human intervention’.1 These provisions give extremely wide discretion to Member States to override the general prohibition. It is significant that EU laws emphasise the need for human rights safeguards, and the need to ensure the possibility of human interventions, but neither of these concepts have yet been adequately defined. Although influential actors like the EU and the Council of Europe have established principles on the ethical and responsible use of AI, there is currently no authoritative guidance on the practical safeguards that need to be in place.2Likewise, the meaning of ‘human intervention’ is open to interpretation. LED provides some guidance on who should be carrying out the human intervention,3 but there needs to be greater clarity on what meaningful human intervention entails in different contexts. In order to regulate the use of AI in criminal justice proceedings, and close the gaps in existing data protection laws, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. Part 1: Regulating the Design and Deployment of AI Systems in Criminal Justice Systems AI systems deployed to assist criminal justice decision-making have to be fit-for-purpose. The purposes of AI systems differ depending on the context in which they are deployed, but there are a few common considerations that need to be taken into account to determine whether it is appropriate for the AI system to be used. Firstly, AI systems have to be designed to produce outcomes that are desirable from a human rights and non-discrimination perspective. This means that rather than being exclusively focused on delivering ‘accurate’ outcomes in criminal cases, AI systems have to be designed to facilitate fair, impartial and non-discriminatory criminal processes. Developers of AI systems and public entities that commission them should, in particular, make sure that AI systems are consciously designed to give effect to, and promote the right to fair trial. The fundamental issues with the way AI systems are designed and built, resulting in discriminatory outcomes, must also be considered. Given the significant evidence of AI systems influencing discriminatory outcomes, special efforts must be made to ensure that AI systems do not produce discriminatory outcomes. Secondly, AI systems need to be designed in a way that makes it possible for criminal defendants and the broader public to scrutinise them. This means that AI systems should not only be made open to scrutiny (rather than concealed to protect commercial interests), but their inner workings and processes should also be discernible and comprehensible. AI Systems should be designed to protect and promote the right to a fair trial Where AI systems are used to assist or inform criminal justice decisions, they support an important act of public administration that has a significant impact on the rights of suspects and accused persons. AI systems do more than just provide outputs that decision-makers can take into consideration as evidence. By attempting to mimic human analytical processes and reasoning, they can provide influential advisory input into human decision-making, or even replace it altogether. As such, it is right that human rights standards that govern criminal justice decision-making also apply to AI systems. The Council of Europe and the EU Commission’s High Level Expert Group on Artificial Intelligence (‘AI HLEG’) have both recognised that fundamental rights should be a key guiding principle for the design and deployment of AI systems.4 The Council of Europe recommends that AI systems are built according to ‘human rights by design’ principles, and recognises that AI systems should not undermine the right to a fair trial under the European Convention on Human Rights (‘ECHR’). The AI HLEG has similarly recognised that the respect for fundamental rights, as enshrined in the EU Charter of Fundamental Rights and international human rights instruments, should form the foundations of trustworthy AI. AI HLEG’s Ethics Guidelines for Trustworthy AI (‘the Ethics Guidelines’) also recognise the need for AI systems to comply with other types of EU legislation. Although not mentioned explicitly in the Ethics Guidelines, Fair Trials would emphasise that the design of AI systems and the ways in which they are deployed in the EU should, in particular, be compatible with the standards set out in the procedural rights directives under the ‘Roadmap for strengthening procedural rights of suspected or accused persons in criminal proceedings’.5 We would also like to note the potential for AI systems to have a positive impact on criminal justice systems. Public debate about the relationship between AI and human rights have predominantly been centred on the idea that AI is a threat to human rights. It is equally important, as technology takes an increasingly prominent role in public life, to consider what positive potential they may have. Policy makers, developers, civil society activists, and other stakeholders should try to identify ways in which AI can also play an active role in advancing human rights, and improve the fairness of criminal justice systems. For example, AI systems could be used to analyse law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination, for preventative purposes. AI systems which are used as part of criminal justice decision-making should be designed not just to ensure that they do not undermine the right to a fair trial, but also to promote it. However, as explained below, given the embedded biases in the criminal data used to develop and train AI systems, there are serious doubts, based on recent studies, whether AI systems can promote fair criminal justice at all. There are various aspects of the right to a fair trial and, without speculating on what kind of AI systems will be developed in the future to support criminal justice decision-making, it is difficult to articulate how fair trial rights standards should inform the design of AI systems. However, examples of AI systems currently deployed in the EU and elsewhere suggest that there are certain aspects of the right to a fair trial that require special attention. These are: a) the right of access to court b) the presumption of innocence; c) the principle of the equality of arms; and d) the right to liberty. Access to Court The notion of AI systems replacing courts to determine the guilt or innocence of the accused may seem far-fetched at present, but there is a growing trend of automated administration of justice across the world that might threaten the right of access to court. For example, in several European countries, speeding and other minor traffic offences have been detected and enforced by means of automated processes for more than a decade.6 Although nominally criminal processes, these types of proceedings are, in reality, normally administrative in nature, and they rarely have a ‘significant’ impact on the rights of individuals. However, as surveillance technology develops, thanks to AI, there is a real likelihood that the scope of crimes punishable by way of automation will increase.7 In the United Kingdom, the government announced plans in 2017 that would enable defendants to enter guilty pleas via an online portal after viewing the charges and evidence against them, for a small number of minor offences.8 Under this procedure, known as ‘automatic online conviction’, defendants would be automatically convicted and fined without any judicial oversight if they accept the charges against them. Although it is debatable whether this system can truly be characterised as an AI system, it is an example of the automated administration of criminal justice, that replaces a function usually played by courts. It is worrying that the UK government has proposed expanding this scheme to other ‘non imprisonable’ offences, if itis regarded as a success.9Fair Trials has outlined concerns about expanding the scope of cases where accused persons can be convicted without judicial oversight, even if such procedures are reserved solely for minor, non-imprisonable offences.10 The impacts of a criminal conviction, even for a minor offence, can be numerous, long-term, and hard to predict, affecting inter alia job prospects, educational opportunities, and immigration status. It is crucial that what amounts to ‘legal effects’ and ‘similar significant effects’ concerning the data subject for the purposes of automated decision-making are interpreted very broadly.11 In particular, given that a criminal record always has a ‘legal’ or ‘significant’ effect, any automated decision-making process that directly results in a criminal record should be prohibited. AI systems should not undermine the right to be tried by an impartial and independent tribunal, and in line with existing EU laws, no individual should be subject to an automated decision that resultsin their being held in custody or detention, gives them a criminal record, or which determines a criminal sentence or sanction. No individual should be subject to an automated decision which engages their human rights without meaningful human input. Presumption of Innocence The right to be presumed innocent in criminal proceedings is a basic human right, and one that is expressly recognised in, and safeguarded by EU law under Directive 2016/343 (the ‘Presumption of Innocence Directive’).12 The increasing use of AI in the sphere of criminal justice, however, raises questions about the scope of this right, and how AI systems should be built and used to protect it. Concerns about how AI systems undermine the presumption of innocence have been voiced in the context of certain types of predictive policing software.13 A variety of predictive policing tools that aim to facilitate preventative policing measures and to deter crimes before they have taken place have been developed and deployed across Europe.14 Tools which predict the time and place where certain crimes are likely to take place have been used in many European countries. Similar tools have also been developed to identify potential suspects, which are used widely in the US, and now increasingly in Europe.15 An example is the ‘Strategic Subject List’ in Chicago, a police database of around 400,000 local residents who were assigned threat scores that determine the likelihood that they will commit crimes.16 The algorithms used to generate these scores were not open to the public, so the exact process by which individual risk levels were assessed were not known. Despite this lack of transparency, it is clear that threat scores generated by the software had significant impacts on individuals’ rights – in particular, their right to privacy. Individuals with higher threat scores were, for example, more likely to be subject to targeted police surveillance, or home visits – as though they were officially recognised as predisposed to commit crimes, irrespective of any credible suspicion of wrongdoing.17 The Strategic Subject List was decommissioned in January 2020 by the Chicago police who cited ineffectiveness as the primary reason for the decision.18 These types of predictive policing tools are now being used in Europe. In the United Kingdom, a coalition of police forces have been developing a system not dissimilar to the Strategic Subject List, that aims to identify individuals who are likely to commit crimes.19 Known as the National Data Analytics Solution (‘NDAS’), this risk assessment tool uses statistical analysis and machine-learning to inform policing decisions, and to facilitate ‘early interventions’ where appropriate.20 The sources of data that the system uses to conduct its risk assessments raise concerns that the system will be built to profile individuals on the basis of very sensitive, personal information, including stop and search data, data from social services, and the National Health Service.21 Where this data is used to indicate the likelihood of individuals’ criminality, it will inevitably flag up people whose profiles fit those who are over-represented in that data as being higher risk. It is particularly worrying that an individual might be profiled for policing purposes on the basis of their health conditions or their access to essential services, such as welfare or benefits. These factors should not be regarded as relevant factors for determining whether someone may commit criminal offences. Also in the UK, the Metropolitan Police in London operates a database called the Gangs Matrix, which contains information and risk-assessments on individuals who are alleged ‘gang’ members.22 This database was created using criminal justice data, including police and crime records. The Gangs Matrix and the assessments it produces assists policing decisions, including the deployment of stop and search, and further enforcement action, such as imprisonment and deportation. A further tactic resulting from the risk assessments made by the Gangs Matrix is the threat of eviction or exclusion from education, as names and details of these alleged gang members have been shared with education, healthcare and housing providers.23 In the Netherlands, the government has been running an algorithmic risk assessment tool, ProKid 12- SI, which purports to assess the risk of criminality of 12-year-old children since 2009.24 ProKid uses existing police data on these children, such as reports of where children have come into contact with the police, their addresses, information about their ‘living environment’, even including whether they are victims of violence, to identify them as being in one of four categories of ‘risk’ of committing crimes in future.25 The system assesses children based on their relationships with other people and their supposed risk levels, meaning that individuals can be deemed higher risk by being linked to another individual with a high risk assessment, such as a sibling or a friend.26 Parents’ assessed risk can also impact a child’s risk level. ProKid’s algorithms assess risks in relation to future actions that the children have not yet carried out, and judges them on the basis of the actions of others close to them.27 These risk assessments result in police ‘registering’ these children on their systems and monitoring them, and then referring them to youth ‘care’ services.28 ProKid frames children as potential perpetrators even when they are registered as victims of violence; which has serious implications on their presumption of innocence.29 Several similar tools are also used in the Netherlands, including the Reference Index for High Risk Youth, a large-scale risk assessment system that focuses on assessing under-23-year-olds.30 Predictive policing tools like NDAS, ProKid and the Gangs Matrix can be regarded as part of a broader trend in law enforcement that moves away from ‘reactive’ policing, and towards ‘preventative’ or ‘proactive’ policing.31 NDAS and other similar predictive policing tools intend to pursue legitimate objectives of preventing, or reducing harm,32 but there are serious concerns that these systems single out individuals as ‘pre-criminals’, who are subject to police interventions even though they are not formally suspected of any crime, and there is no evidence that they have done anything wrong.33 It is of further concern that these types of predictive policing tools do not necessarily designate individuals’ risk levels on the basis of their past actions, or behaviour that can be regarded as ‘suspicious’ in any way, but on account of factors far beyond their control, and immutable characteristics. In particular, there is strong evidence to suggest that AI systems have a tendency to overestimate the risks of criminality of certain ethnic and racial groups. For example, out of 3,800 people on the Gangs Matrix, 80% are 12-24 years old, and 78% of them are black – a clearly disproportionate and discriminatory proportion. The discriminatory impact of AI in criminal justice systems is discussed in further detail in the following section. Although predictive policing tools do not directly ‘convict’ people, they not only allow the police to treat legally innocent individuals as pseudo-criminals, but they can also result individuals being deprived of their basic rights with regard to education, housing, and other public services – effectively ‘punishing’ them on account of their profiles. This seriously damages the fundamental human rights principle that the matter of guilt or innocence can only be determined by means of a fair and lawful criminal justice process.34 While it is clear that certain types of predictive policing can infringe the presumption of innocence from a moral and ethical viewpoint, it is debatable whether these systems also violate the legal presumption of innocence under EU law and international human rights law. The Presumption of Innocence Directive applies to natural persons who are ‘suspects’ and ‘accused persons’, from the moment they are suspected or accused of a crime.35 However, there is some ambiguity about the exact stage at which an individual attains the status of a ‘suspect’ under the Presumption of Innocence Directive,36 and about whether the scope of the Presumption of Innocence Directive extends to decisions to designate an individual as a suspect (or a ‘pre-criminal’). On the other hand, the ECHR appears to have taken a clearer position that measures undertaken pre-charge, as a general rule, fall outside the scope of the presumption of innocence.37 It has also held that preventative measures, such as surveillance, do not amount to criminal sanctions for the purposes of Article 6 ECHR.38 Even if the current language on the presumption of innocence is such that it is not directly applicable to the predictive policing context, it must be recognised that these tools nevertheless interfere with human rights. In particular, the targeted surveillance that results from predictive policing has clear implications on the right to privacy. The acceptable degree to which criminal justice processes can interfere with this right is a matter that might require clearer articulation, as is the question of the impact of Article 8 ECHR violations on criminal proceedings. AI systems that inform charging decisions have also been developed and deployed. An example of this is the Harm Assessment Risk Tool (‘HART’) currently being used by Durham Constabulary in the United Kingdom. HART uses a machine-learning algorithm to assess a suspect’s risk of reoffending, using over thirty variables that characterise an individual’s criminal history and socio-demographic background. The risk assessments conducted by HART are used by the local police to determine whether an individual should be charged, or diverted into a rehabilitation programme. HART does not determine whether an individual is guilty or innocent, but its assessment can trigger a chain of events that can result in the deprivation of liberty, and/or a criminal conviction. Charging decisions should surely be based on the merits of individual cases, and it is difficult to imagine how decisions on entry into diversion programmes can be made by means other than a careful consideration of individual circumstances. These types of high impact, fact-sensitive decisions should never be delegated to automated processes, particularly those which operate by identifying correlations rather than causal links between an individual’s characteristics and their likely behaviour. An examination of HART also reveals flaws in how the tool is designed. HART is calibrated to err on the side of caution,39 because it regards under-estimations of risk levels as a more serious error than over-estimations, so that under-estimations occur less frequently. In other words, HART is deliberately designed to underestimate who is eligible for entry into the diversion programme, so it is predisposed to over-criminalise. This approach conflicts with the notion that any doubt in a criminal case should be interpreted in favour of the defendant (‘in dubio reo’).40 A human rights compliant approach to criminal justice decision-making would do the opposite of what HART does – it would need to err on the side of the defendant. AI systems should respect the presumption of innocence and they must be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow or assist the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Equality of Arms A major concern raised in the studies of certain AI systems is that they are inaccessible for adequate scrutiny by defendants and their lawyers. This has serious implications for the principle of equality of arms and the right to an adversarial process, because without information about how a decision is made, it is difficult to envisage how defendants can question the accuracy and legality of the decision. The need for AI systems used in criminal justice to be transparent, explainable and understandable to all is addressed in more detail below. The Right to Liberty In the United States, ‘risk-assessment’ tools that use AI technology have been used to assist pre-trial assessments that determine whether a defendant should be released on bail, or held on remand pending their trial. Examples of risk-assessment tools currently being used in the United States include COMPAS, the Public Safety Assessment (‘PSA’), and the Federal Pre-Trial Risk Assessment Instrument (‘PTRA’). Many of these tools are also used to inform decisions on parole and sentencing. These tools have, however, been subject to intense criticism for several reasons. Studies have shown inter alia that risk assessments make inaccurate predictions that are no better than those made by non-expert humans. They do not result in a significant reduction in pre-trial detention rates, and that they produce disparate outcomes for different racial groups. The US-based NGO Partnership on AI has found that AI risk assessment tools currently being used in the United States are unfit for use in pre trial assessments, and it has recommended that policymakers cease the deployment of risk assessment tools until such time that the challenges affecting such tools have been adequately addressed.41 The adoption of pre-trial risk-assessments tools in the United States has largely been driven by the desire to address high imprisonment rates in the country by making pre-trial decision-making fairer. In particular, these tools have been promoted as an alternative to cash bail – a system often criticised for disadvantaging poorer defendants and worsening social injustices.42 Cash bail is a relatively rare concept in the EU, but there are concerns about the quality of pre-trial detention decisions in many Member States, which have been criticised for failing to carry out case-specific reviews and fully consider alternatives to detention.43 We are currently unaware of any attempts in EU Member States to introduce algorithmic risk assessments to supplement or replace existing pre-trial decision-making processes. However, it is possible that risk-assessment tools will also be recommended as a solution to address the pre-trial detention challenge in Europe, especially given that many of these tools are developed by private companies that actively market their products to governments and local police forces. Risk-assessment tools are usually designed to assess the likelihood of re-arrest, and/or of failure to turn up to court after being released based on the profiles of the defendant. Based on these assessments, risk assessment tools either assign risk levels to defendants, or they provide direct advice to decision-makers on whether or not the defendant should be released. There is only limited research about the extent to which pre-trial risk-assessment tools influence judges’ decisions in practice,44 but concerns have been raised about the ability of AI systems to recommend detention at all.45 There is a risk that recommendations made by AI systems to detain individuals compromise the presumption of release. This is a particularly valid concern in light of research suggesting that decision-makers have a tendency to err on the side of caution when they are ‘advised’ by AI systems, and that they have a greater propensity to override risk assessment tools to detain, rather than release defendants.46 Pre trial detention should always be a measure of last resort, and no risk-assessment can be regarded as human rights compliant, unless it recommends its users to consider detention as a measure of last resort, after all other alternatives have been fully considered. Pre-trial risk assessment tools in the United States and elsewhere have also been criticised for (unintentionally) over-estimating risks, because of the nature of the data used to train its algorithms. Pre-trialrisk assessment tools typically rely only on data regarding individuals who have been released, and they ignore those who were detained, but would have otherwise ‘succeeded’ by not being arrested, and by appearing in court.47 In other words, algorithms are based on the assumption that individuals who have been detained by courts in the past have been rightfully deprived of their liberty. Any AI system developed to assist pre-trial detention decision-making must be designed to give effect to the presumption in favour of release. This means that risk-assessment tools need to be deliberately calibrated to generate outcomes that favourable to the defendant. Data used to train the AI system should be carefully scrutinised so that it reflects the inevitable fact that a significant proportion of individuals in pre-trial detention have been deprived of their liberty in violation of their human rights. Studies of pre-trial risk-assessment tools used in the United States cast doubt on their effectiveness at reducing pre-trial detention rates, and their ability to make accurate predictions of risks. A study in Kentucky, for example, found that the likelihood of defendants being released within the first three days of their arrest went down after the risk-assessment tool was deployed, and that there were no significant changes in the number of re-arrests and failure-to-appear rates amongst defendants released on bail during the same period.48 This was the case even after the risk-assessment tool was modified post-deployment to improve the accuracy of predictions. Another study has found that the COMPAS risk-assessment tool is no better at predicting the likelihood of defendants reoffending than non-expert human volunteers.49 These studies do not necessarily prove that AI systems are incapable of reducing pre-trial detention rates at all, but they do raise questions about their usefulness, and they strongly challenge claims that algorithmic risk-assessment tools help to improve the quality of pre trial detention decisions. They also highlight the need for post-deployment testing and monitoring of AI systems, to ensure that they have the desired effect of ensuring that individuals are detained only as a measure of last resort. Post-trial assessment systems are also being increasingly used, for purposes such as assisting with sentencing decisions or prisoner release. In England and Wales, the Prison and Probation Service has developed and operates the Offender Assessment System (OASys), an automated risk-assessment tool.50 It assesses the risk of harm offenders pose to others and how likely an offender is to reoffend, as well as assessing offender needs. These risk assessments are used to decide ‘interventions’ and to influence the sentence plans given to offenders.51 Millions of these assessments have been carried out.52 The system collates information on offenders’ previous offences, education, training, employment, alcohol and drug misuse; as well as their ‘attitudes’, ‘thinking and behaviour’, ‘relationships’, and ‘lifestyle’.53 This data is used alongside the individual’s offending record and ‘offender demographic information’ to inform two predictive algorithms: OASys General Reoffending Predictor (OGP1) and OASys Violence Predictor (OVP1).54 A 2014 National Offender Management Service analysis found that the OGP1 and OVP1 generated different predictions based on race and gender. They found that relative predictive validity was better for white offenders than for Asian, black, or mixed ethnicity offenders. The Offender Group Reconviction Scale (OGRS) is another algorithmic risk assessment tool, which is used in England and Wales to assess and predict an offender’s likelihood of reoffending.55 The OGRS algorithm uses data on the individual’s official criminal history, as well as their age and gender, to produce a risk score between 0 and 1 of how likely an offender is to reoffend within one or two years. The use of these AI systems in a post-trial setting, and the documented differences in predictive outcomes based on, among other factors, race, highlight the clear need for strict testing and monitoring of such systems. These systems used in a post-trial setting could very easily be transferred to a pre-trial risk assessment setting; the principles and aims of these systems and the data used are very similar. For example, the COMPAS system, mentioned above and considered in more detail below, was originally designed as a recidivism risk assessment tool, and is also used as a pre-trial risk assessment tool. 56 Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure they have the desired effect of reducing rates of pre-trial detention rates. AI systems should be designed to be non-discriminatory One of the most frequent criticisms of AI systems and their use in criminal justice systems is that they can lead to discriminatory outcomes, especially along racial and ethnic lines. The best-known example of this is a study by the US media outlet ProPublica into COMPAS, a risk assessment tool designed to predict the likelihood of reoffending in Broward County in Florida. ProPublica found that COMPAS was 77% more likely to rate black defendants as ‘high-risk’ than white defendants, and it was almost twice as likely to mislabel white defendants as lower risk than black defendants.57 The dangers of the failure to adequately regulate the use of AI to prevent discrimination have also been witnessed in Europe. The ‘Crime Anticipation System’ (‘CAS’), a predictive policing software being used across the Netherlands, was initially designed to consider ethnicity as a relevant factor for determining the likelihood of a crime being committed. Amongst the indicators used by CAS to predict crimes in a particular area was the number of ‘non-Western allochtones’ in the area – in other words, ‘non-Western’ individuals with at least one foreign-born parent.58 The software not only presupposed the existence of a correlation between ethnicity and crime, but also singled out a category of ethnicities to be of particular concern, given that the presence of ‘Western’, ‘autochtone’ individuals were not used as indicators. Furthermore, given that ‘Western’ was defined somewhat subjectively (for example, including individuals of Japanese or Indonesian origin, and including all European nationalities, apart from Turkish), CAS incorporated highly questionable societal categorisations and biases. In the United Kingdom, a major criticism of HART has been that it included data collated and classified by a private company for marketing purposes that could very easily to biased outcomes. HART relied on the ‘Mosaic’ code developed by a consumer credit reporting company, that categorised individuals into various groups according to inter alia their ethnic origin, income, and education levels. It was of particular concern that some socio-demographic categories used by Mosaic were blatantly racialised, including, for example, ‘Asian Heritage’, which stereotyped individuals of ‘Asian’ origin as being unemployed or having low-paid jobs, and living with extended families.59 In Denmark, an automated algorithmic assessment has been used to classify different neighbourhoods, based on criteria such as unemployment, crime rates, educational attainment, and other ‘risk indicators’, as well as whether the levels of first and second-generation migrants in the population is more than 50%. Neighbourhoods which meet these criteria are classified as ‘ghettos’. These neighbourhoods are then subject to special measures, including higher punishments for crimes.60 It is clearly discriminatory, as well as entirely unfair, for people living in certain areas to be punished more severely than others in different areas for the same crimes. Further examples of criminal justice AI which have been identified as producing discriminatory outcomes include the previously mentioned OASys, NDAS and the Gangs Matrix in the UK, and the Netherland’s ProKid 12. These examples illustrate the need for regulations to ensure that AI systems are designed to be non discriminatory, and to exclude categorisations and classifications that deepen and legitimise social biases and stereotypes. However, policy makers should not assume that making AI systems blind to all protected characteristics will always help to produce non-discriminatory outcomes. In certain scenarios, the removal of protected characteristics from the data could worsen discrimination. For example, it has been suggested on the basis of research into COMPAS in the United States, that excluding gender as a variable for risk assessments would fail to reflect a well-established statistical fact that in most countries, women are less likely to reoffend than men.61 Making COMPAS gender blind would unfairly and inaccurately assume women to be as equally likely to reoffend as men, and discriminate against them by overestimating their risk scores. Removing visible biases from AI systems cannot be the sole or primary solution to their discriminatory impact, because AI systems can be biased even if they have not been deliberately designed in that way. Bias is often unintentional, and even if the AI system appears on the surface to be neutral, their algorithms can lead to discriminatory assessments and outcomes. COMPAS, for example, does not include race or ethnicity as a variable, yet research has found that it consistently gives black defendants higher risk scores than their white counterparts, making them less likely to be released from detention.62 Hidden biases can arise in AI systems in numerous ways. Although a comprehensive analysis of how they can cause unintentional biases are beyond the scope of this paper,63 the way in which AI systems are themselves created and built illustrate the difficulty, complexity, and sometimes impossibility, in preventing discriminatory outputs and effects of AI systems. There are fundamental issues with the way AI systems are designed and created which can lead to bias. Where the AI system is based on machine-learning, biases can result from faults in the data that is used to train its algorithms. Machine learning systems ‘learn’ how to make assessments or decisions on the basis of their analysis of data to which they have previously been exposed. However, the data used to train a machine learning system might be incomplete, inaccurate, or selected for improper reasons, and this could lead to AI systems producing unwanted outcomes. What amounts to appropriate, good quality data for the purpose of training algorithms depends on what the machine learning system is being designed to do,64 so it might not always be obvious which dataset is needed to train algorithms to be non-discriminatory. AI designed or created for use in the criminal justice system will almost inevitably use data which is heavily reliant on, or entirely from within, the criminal justice system itself, such as policing or crime records. This data does not represent an accurate record of criminality, but is merely a record of policing – the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data might not be categorised or deliberately manipulated to yield discriminatory results, but it may reflect the structural biases and inequalities in the society which the data represents. Where there are discriminatory policing patterns targeting certain demographics, or the systematic under-reporting and systematic over-reporting of certain types of crime and in certain locations,65 the use of such data merely results in a reinforcing and re-entrenching of those inequalities and discriminationin criminal justice outcomes. For example, according to UK crime data, black people are over 9 times more likely to be stopped and searched than white people,66 and black men are more than 3 times more likely to be arrested than white men.67 Despite these statistics, NDAS (mentioned above) in the United Kingdom explicitly relies on stop and search data to determine an individual’s propensity to commit a criminal offence. The fact that stop and search is disproportionately used against black people means that there will inevitably be an overrepresentation of black people in NDAS and that their risk levels will be inflated in comparison to white people. Comparable statistics on stop and search are not available in most EU Member States, where the official collection of racially disaggregated criminal justice data is either forbidden by law, or not standard practice. However, recent studies show that racially biased policing practices are prevalent throughout the EU. Data collected from a survey by the Fundamental Rights Agency, for example, has shown that during a 5-year period, 66% of individuals of Sub-Saharan African origin in Austria, and over half of respondents of South Asian origin in Greece were stopped and searched.68 AI built on data embedded with such biases and used to assist, inform, or make decisions in the criminal justice system, can expand and entrench the biases represented in the data.69 When AI systems result in criminal justice outcomes which repeat the discrimination inherent in the historic data, such as targeting individuals from a particular demographic, that decision will itself be preserved in the data. This leads to self-perpetuating ‘feedback loops’ which reinforce patterns of inequality.70 Another way in which AI systems can produce unintentional biases is by way of proxies. Data used by AI systems might be classified in seemingly legitimate ways, but those classifications can sometimes act as proxies for protected characteristics. A common example used to illustrate this point is how home addresses or postcodes can be proxies for race or ethnicity.71 Certain AI systems, such as HART, were initially trained to find correlations between home addresses and the risk of reoffending – in other words, to identify which postcode areas have ‘higher-risk’ residents than others.72 This approach overlooks the fact that there is very pronounced ethnic residential segregation in many countries,73 making it highly probable in practice, for AI systems to inadvertently establish a link between ethnic origin and risk. Roma are especially vulnerable to this form of proxy discrimination, given that in many EU Member States, Roma are reported to live primarily in segregated areas inhabited mostly or exclusively by Roma.74 There are several ways in which AI systems can be designed to mitigate the risks of discrimination, including by identifying and excluding data classifications that act as proxies for protected characteristics.75 However, it can be difficult in practice to identify which variables are proxies for protected characteristics (and how they do so), and removing too many ‘offending’ variables might result in the AI system losing much of its functional utility.76 There is no one-size-fits-all method of ensuring that AI systems do not produce discriminatory outcomes. Different approaches to de-biasing AI systems can conflict with one another, and the suitability of a particular de-biasing method might depend on the AI tool itself, and the legal and policy context in which it is designed to operate.77 Biases in AI systems are often not easy to detect and, in many cases, it might also be difficult to pinpoint flaws either in the system itself, or in the training data that has been caused the bias. The structural bias within the data that AI systems are built and operated on, a bias which is particularly deep-rooted in criminal justice data, is a fundamental issue, and one which is likely to result in AI systems being fundamentally inoperable – both because the bias makes them morally and ethically inoperable, if not yet legally, and because any attempts to remove the bias will make the data to operate these systems unusable. Fair Trials’ view is that the only effective way in which AI systems can be regarded as non discriminatory is if they have been subject to rigorous independent testing for biases. These tests must be mandated by law, must be independently run, have clearly stated aims or objectives, and be carried out pre-deployment to reduce the likelihood of individuals being affected by discriminatory profiling and decisions. AI can be tested in advance of deployment by using test data – datasets which are either synthetic datasets,78 or by using historic data with permissions – running it through an AI system, and analysing the outputs.79 For example, a trial of retrospective facial recognition video analysis is being run by a police oversight Ethics Committee in the UK. The trial is using historic data – CCTV footage – as the basis for simulated investigations in a controlled environment, monitored by researchers. The trial has clearly stated aims and signifiers of success, and all outcomes will be examined. There are significant human rights, data protection and ethical concerns involved with this particular technology, including the right to privacy, and the testing is not being conducted independently as it should be but, as above, there are positive aspects of the testing methodology.80 An alternative could be to ‘test’ a system in a strictly academic sense by running it alongside actual criminal justice processes, but with the system not having any effect on decision-making, and analysing the system’s proposed decisions or outcomes for bias. AI should never be used or even ‘tested’ in real-world situations where they have actual effects on individuals or criminal justice outcomes, before they have been tested. These types of tests also need to be carried out in the broader context of an AI governance framework that not only analyses the potential impact of the AI system pre-deployment, but also continues to monitor its impact afterwards. If these tests are not carried out, and/or if an AI system cannot be proven to be non-discriminatory, it should be legally precluded from deployment. However, as explained in the final section of this paper, it is questionable whether such tests are feasible in many Member States, where local laws prohibit the collection of racially-disaggregated data. AI systems should be developed to generate non-discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race or ethnicity. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. If an AI system cannot be proven not to generate discriminatory outcomes, it should not be used. AI Systems need to be transparent and explainable AI systems can have a significant influence over criminal justice decisions, and they should be open to public scrutiny in the same way that all decision-making processes by public entities should be. However, a common criticism of many AI systems is that they lack transparency, which often makes it difficult, if not outright impossible, to subject them to meaningful impartial analysis and criticism. This lack of transparency is both as a result of deliberate efforts to conceal the inner workings of AI systems for legal or profit-driven reasons, and of the nature of the technology used to build AI systems that is uninterpretable for most, if not all humans. There are several reasons why it is necessary for AI systems to be transparent. Firstly, transparency is essential for strengthening confidence of both primary users of the system, as well as the general public, in AI systems. Democratic values demand that the public needs to be aware of how powerful public institutions, such as the police and the judiciary, operate so that they can be held accountable for their actions. It is also crucial for primary users of AI systems to understand how they work, so that they can make informed decisions about how much influence they should have on criminal justice decisions. Secondly, decisions made by AI systems need to be contestable at an individual level. Standards on the right to a fair trial and the right to liberty demand that defendants should have access to materials that inform decisions regarding them, so that they can challenge the accuracy and lawfulness of those decisions. Transparency also acts as a safeguard against bias and inaccuracies. It is difficult to imagine how issues that undermine the fairness and accuracies of AI systems (such as racial biases) can be detected, and ultimately fixed, if they cannot be properly accessed and analysed. As explained above, certain AI systems, such as CAS, have been found to have serious, but very obvious, flaws. In CAS’s case, however, the fault in the software could be detected easily, which meant that the discriminatory impact of the tool could be mitigated. The indicator for ‘non-Western allochtones’ in CAS was removed in 2017,81 ostensibly because it served no useful purpose, but presumably also because of the very obvious bias. This mitigation was possible because CAS is a transparent software, that was developed in-house by the Dutch police. The types of indicators used to predict crime were made openly available, and information about the method by which the software made predictions could easily be accessed and understood.82 This, however, is not the case for all AI systems, because AI systems are often developed by for-profit companies with little to no meaningful input from the public. As such, details of how they are designed, and how they make decisions and assessments are, in many cases, closely guarded as trade secrets that are protected by law.83 Often, AI systems are ‘black boxes’ because they are deliberately kept that way. While it is accepted that strong, enforceable intellectual property laws are needed to promote advancements in what is a very dynamic field of scientific research and innovation, it is not acceptable that these concerns trump the rights of individuals suspected or accused of crimes. In light of this, it is concerning that the Commission’s White Paper focuses on, and strongly promotes, the concept of a ‘partnership between the private and the public sector’ in relation to AI.84 Fair Trials appreciates that effective public-private collaboration could help to fill in gaps in public sector expertise and capacity for the development of AI systems, but given the transparency challenges, it is essential thatsuch partnerships are accompanied by robust regulations and rules that ensure effective and open scrutiny. However, even if AI systems are completely exposed to public scrutiny, and their source code85 and input data, for example, are openly disclosed, there is still no guarantee that they will be sufficiently transparent to enable adequate independent scrutiny. AI systems can be black boxes by nature of the technology that makes their decision-making processes complicated beyond comprehension for most (in some cases, too complicated even for computer scientists to understand).86 This is especially the case where AI systems are based on machine-learning algorithms. One possible reason for the unintelligibility of AI systems is that they sometimes use machine-learning algorithms that are simply too complex to be understood to a reasonable degree of precision.87 This is especially the case where AI systems incorporate ‘Deep Neural Networks’ – a machine-learning algorithmic architecture inspired by the structure and mechanics of human brains. Rather than relying on a set of man-made instructions, these types of AI systems make decisions based on experience and learning. Decision-making processes of this kind have been described to be ‘intuitive’, because they do not follow a defined logical method, making it impossible to analyse the exact process by which a particular decision is reached.88 It has also been suggested that some AI systems are uninterpretable to humans because the machine-learning algorithms that support them are able to identify and rely on geometric relationships that humans cannot visualise. Certain machine-learning algorithms are able to make decisions by analysing many variables at once, and by finding correlations and geometric patterns between them in ways that are beyond the capabilities of human brains.89 Given these challenges, there is widespread recognition that states should require AI systems to not only be ‘transparent’, but also explainable and intelligible.90 GDPR already recognises that individuals should have the right to an explanation of how a decision was reached, if they have been subject to an automated decision.91 In principle, this is an essential and very useful requirement, but it is also one that seems difficult to implement in practice, given that both ‘explainability’ and intelligibility are highly subjective concepts. Arguably, AI systems’ computing processes are inherently difficult to explain and understand for most people, including for most criminal justice decision-makers, but this surely should not be the sole basis for oversimplifying the technology, or for banning the use of AI outright. Computer scientists have been theorising different ways of ensuring that decisions made through complex algorithms can be explained and understood. An example is the ‘explainable AI’ movement (‘xAI’) that aims to build AI systems that can show more discernible links between inputted data and decisions. xAI systems measure how each input influences the final decision, so it is possible figure out how much weight is given to each input.92 This seems to be an innovative response to the ‘black box’ challenge, establishing clearer, more helpful relationships between inputs and final decisions. However, it appears to fall short of explaining what happens between data being inputted into the system and the final decision, and it does not enable users to impute any logic to the decision-making process.93 As explained above, there are various reasons why AI systems need to be transparent and intelligible, but the effective of exercise of the rights of the defence must be recognised as a crucial test for determining whether an AI system is sufficiently explainable and intelligible. AI systems have to be designed in a way that allows criminal defendants to understand and contest the decision made against them. Partnership for AI has suggested that a central factor that determines the contestability of AI systems is the possibility of carrying out an audit trail of the AI decision.94 In particular, it has to be possible for an auditor to follow and reproduce the process and come to the same conclusion reached by the AI system at the end. Furthermore, as explained in further detail below, criminal justice procedures should require the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings, and this disclosure should be in a form which is understandable to a layperson, without the need for technical or expert assistance. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, as well as the general public. Commercial or proprietary interests, or technical concerns, should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decision made against them. It should be possible to carry out an independent audit, and processes should be reproducible. Part 2: Safeguards for the use of AI Systems in Criminal Proceedings AI systems have to be built in accordance with human rights principles, and to give effect to human rights in practice, but it is unlikely that their design alone will guarantee that they are used in ways that comply with human rights. Regulatory frameworks for the design and deployment of AI systems have to be accompanied by appropriate legal safeguards that ensure they are used responsibly and lawfully. There are two primary questions that need to be addressed: 1) how procedural rules ensure that decision-makers do not over-rely on AI systems; and 2) how decisions and assessments made by AI systems can be analysed independently and challenged. Combatting ‘Automation Bias’ and Reinforcing Meaningful Human Input One of the main challenges of automated, or semi-automated decision-making systems is that of ‘automation bias’ – the tendency to over-rely on automation in ways that can cause errors in decision making. Automation bias occurs primarily due to the perception that automated decision-making processes are generally trustworthy and reliable. Automated cues have been found to be particularly salient to decision-makers, and research has shown that users of automated decision-making systems have a tendency to place greater weight on automated assessments over other sources of advice.95 The disproportionate influence of automated systems can undermine the quality of decision-making, by discouraging its users from consulting a wider range of factors that could inform more accurate decisions. Most AI systems currently being used to assist criminal justice decision-making do not completely replace human decision-making. They are instead designed and deployed to be used as decision aids, whose outputs are factored into consideration for the purposes of human decision-making. The phenomenon of automation bias however, raises questions about whether AI systems are being used in reality in accordance with their intended purpose as decision aids, and not as de facto replacements for human decision-making processes. There is strong evidentiary basis for automation bias amongst pilots who, like judges and other decision-makers in criminal justice proceedings, have typically been through a high level of training to make appropriate decisions in highly complex settings.96 However, limited research into automation bias amongst judges suggests that AI systems might have a more complex impact on judges’ behaviour. For example, a study conducted in 2019 in Kentucky seems to suggest that the degree to which judges rely on predictive tools for pre-trial detention decision-making could be influenced by the ethnicity of the defendant.97 The research indicates that judges had a greater tendency to rely on algorithmic risk assessments where the defendant was white, whereas in cases where the defendant was black, judges were more likely to overrule the risk-assessment in favour of detaining them. This study appears to show that AI systems can influence judges’ behaviour in unpredictable ways, especially where there are interactions or conflicts between automation and human biases, and that AI systems might be an ineffective tool for challenging human prejudices. It is crucial that rules governing the use of AI systems in criminal proceedings actively try to counter automation bias, and to encourage decision-makers to make independent determinations. A simple requirement to have a human decision-maker ‘in the loop’ or to have a human decision-maker review or check the automated decision is insufficient, because this risks overestimating the capacity or willingness of human decision-makers to question and overrule automated decisions. A mere requirement to have an automated decision reviewed by a human, on its own, could reduce the human review into a rubber-stamping exercise which, in practice, is no oversight at all. In recognition of this challenge, the European Data Protection Board has recommended that in order for decisions to be regarded as not ‘based solely’ on automated processing for the purposes of Article 22 GDPR, there has to be ‘meaningful’ human oversight, rather than just a token gesture.98 What qualifies as ‘meaningful’ intervention is open to interpretation, and it is likely to differ depending on the circumstances and the type of decision being made. In the context of criminal justice procedures, where decisions often have particularly severe and far-reaching implications for individuals’ rights, safeguards for ensuring meaningful human intervention have to be especially robust. Procedural safeguards that ensure ‘meaningful’ human oversight Rules governing the use of AI systems in criminal justice proceedings have to counter automation bias by encouraging human decision-makers to treat their processes with scepticism, and to force them to challenge and scrutinise the outcomes of algorithmic assessments. Procedural safeguards that can be put in place to tackle automation bias include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easier for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. One way of ensuring that automated assessments and decisions do not have undue influence on judicial decisions might be to ensure that decision-makers are sufficiently informed and alerted about the risks of relying on AI systems. This seems to be the approach taken by the Wisconsin Supreme Court in the United States in the case of Loomis,99 in which the Court considered whether or not the use of the COMPAS risk assessment tool for sentencing purposes violated due process rights. The judgment in Loomis recognises the importance of procedural safeguards as a way of safeguarding fairness of decisions, by requiring the use of ‘written advisements’ to alert decision-makers about the potential risks of AI risk assessments. Specifically, the court mandated that these advisements had to include warnings that: a) the process by which the COMPAS produces risk scores were not disclosed due to its ‘proprietary nature’; b) the accuracy of risk scores are undermined by the fact that COMPAS relied on group data; c) the risk-assessment tool had never been tested locally for accuracy; d) ‘questions’ have been raised about the discriminatory effect of COMPAS risk-assessments; and e) COMPAS was developed to inform post-sentencing decisions, but not sentencing decisions themselves. These warnings are clearly very specific to COMPAS and the context in which it is used in Wisconsin. If similar safeguards were adopted in different contexts and with regard to different AI systems, advisements will no doubt need to be adapted. The warnings used in Loomis have, however, been criticised because they do not give enough information to decision-makers to enable them to appreciate the degree to which these risk-assessments should be discounted.100 In particular, the advisements are silent on the strength of the criticisms against COMPAS, and they say nothing about the basis on which questions about their discriminatory effect have been raised.101 These warnings also give no indication about likely margin of error of the assessment, so although judges are informed that some assessments might be inaccurate, they are not in a position to appreciate how serious or frequent these errors might be. ‘Advisements’, or warnings that encourage decision-makers to be sceptical of AI systems cannot be considered as effective safeguards, unless they contain sufficiently helpful information for decision makers. However, even if judges are given stronger warnings than those in the Loomis advisements, it is still doubtful whether they alone will adequately mitigate automation bias. One reason for this is that many criminal justice decisions (such as pre-trial detention decisions) are, in practice, made very routinely by judges. Although written advisements might initially help judges think more critically about automated risk assessments, over time, these advisements could become repetitive and routine, and lose much of the intended meaning and effect.102 An effective safeguard that could work in conjunction with mandatory warnings could be for decision makers to be given a better insight into how AI systems produce a particular assessment or calculation. As mentioned above, the lack of information about how assessments are made by AI systems makes it harder for criminal defendants to scrutinise and challenge them. Surely, this has to be true also for decision-makers. It is much harder, if not impossible, to analyse and criticise decisions if there is no reasoning behind them. While AI systems do not rely on ‘reasoning’ per se, information given to decisions about how a specific assessment was made, including what factors were relevant, and how much weight was given to each factor could give decision-makers more confidence to decide whether to agree or disagree with an AI-generated decision. Decisions or assessments made by AI systems cannot be the sole basis of criminal justice decisions – they should be no more than a factor that can influence human-decision making. As such, decision makers should be required to show that decisions were influenced by a broader range of factors other than the AI system, by way of fully reasoned, case-specific, written decisions. Research has shown that the lack of case-specific reasoning in pre-trial detention decisions is already a serious challenge in many EU Member States,103 and AI systems risk worsening the standardisation of such decision making processes. Where AI systems are used to inform pre-trial detention decisions, or any other criminal justice decision that has a significant impact on the rights of the defendant, reasoned decisions must be specific to the defendant’s case, and in particular, they must reveal what which factors influenced the decision, and to what degree. In particular, decisions have to make it clear how much weight was given to assessments by AI systems. It is also crucial that decision-makers are able to override decisions made by AI systems, and that they are confident about doing so where the tool produces assessments or recommendations that are unfavourable to the defendant (e.g. where the AI system advises against releasing the defendant). It has been reported that members of the police force in Avon and Somerset Police in the United Kingdom are expected to record incidences where they have disagreed with assessments made by a predictive policing tool, and to explain their reasons for the disagreement.104 This is likely to act as a strong disincentive for overriding decisions made by the AI system, and as such, it actively facilitates automation bias. Furthermore, it seems to interfere with the presumption of innocence by making it difficult for decision-makers to override AI systems to make decisions that favour the defendant. If an AI system recommends the arrest or the detention of an individual, decision-makers should feel that they have a genuine choice of overruling the AI system, and not be pressured into compliance. Criminal justice decision-making processes should, as a general rule, be skewed in favour of the defence to give effect to the presumption of innocence, and rules governing the use of AI systems should favour favourable outcomes for defendants. On the other hand, in cases where a decision-maker acts against the advice of an AI system that recommends a favourable outcome for the defendant, there should be a requirement for reasons to be given for their decision. This is to prevent unfavourable outcomes for defendants that are motivated by improper reasons, and to mitigate the risk of unconscious bias. Challenging AI in criminal proceedings AI systems need to be contestable by criminal defendants. This is so that they can not only challenge the outcomes of the AI systems’ calculations and analyses, but also scrutinise the legality of their use. In other words, being able to challenge AI systems in criminal proceedings is not only a procedural fairness requirement for defendants, it is also a means by which legal standards governing AI systems and their use can be enforced. One of the major issues preventing the sufficient contestability of AI systems in criminal proceedings is the lack of notification. If an individual is not notified that they have been subject to an automated decision by an AI system, they will not have the ability to challenge that decision, or the information that the decision was based on. For example, in the United Kingdom, the Data Protection Act 2018 sets out the applicability of the GDPR and sets out the UK’s interpretations of the GDPR’s requirements and safeguards. However, section 14 of the Data Protection Act significantly dilutes the requirements of Article 22 of the GDPR, permitting purely automated decisions which have legal or similar significant effects on a data subject, without their consent, as long as the data subject is subsequently notified that a purely automated decision has been taken about them, after the decision has been made. It is only then that the data subject has the opportunity to request a new decision. However, it has been reported that individuals subject to decisions by the HART system in the UK are not notified at all that they have been subject to such an automated decision, even after it has been made.105 This is likely because under the Data Protection Act 2018, automated decisions which have legal or similar significant effects on a subject are not necessarily classified as ‘purely automated’ if a human has administrative input. In order to meet this requirement, the human input can be as minimal as checking a box to accept the automated-decision, even if it has a significant impact on an individual, such as holding them in custody. This minimal requirement for human requirement means that, in practice, decisions made with negligible to no meaningful human input can be classified as not “purely automated” and there is no legal requirement to notify and ability to request a new decision. In this way, systems such as HART continue to be used, with people subject to their decisions completely uninformed. While the GDPR already requires the notification of individuals affected by automated decisions, the UK’s experience with HART highlights the need for stricter rules to not only ensure meaningful human input (as mentioned above), but to also strengthen the individual’s right to be notified. There must be a requirement for individuals to be notified, not just for “purely automated” decisions, but whenever there has been an automated decision-making system involved, assistive or otherwise, that has or may have impacted a criminal justice decision. This notification should include clear and comprehensible information about the decision that has been taken, how that decision was reached, including details of the information or data involved in reaching that decision, what the result or outcomes of the decision are, and what effects, legal or otherwise they have, and information on how to challenge that decision. As discussed in the previous section, a further major barrier to the contestability of AI systems is a technical one. The ‘black box’ nature of certain AI systems can be largely attributed to their design, so it is important that there are rules governing the interpretability of these systems so that when they are in use, their processes can be understood at all. However, there are also legal barriers to the full disclosure of AI systems, which are often put in place to protect commercial interests. Procedural safeguards play a particularly important and effective role in addressing these types of opacity challenges. Transparency is a fundamental aspect of an adversarial process that underpins the right to a fair trial, and human rights standards require that as a general rule defendants should be given unrestricted access to their case-file,106 and to be given the opportunity to comment on the evidence used against them.107 These standards are further reinforced by Directive 2012/13/EU,108 which requires Member States to grant access to all material evidence in possession of the competent authorities to the defence to safeguard the fairness of the proceedings and to enable defendants to prepare their defence.109 The procedural requirement of an adversarial process is not one that is limited to substantive criminal proceedings – it also applies in the context of pre-trial decision-making processes, especially for decisions on the deprivation of liberty.110 While EU law and international human rights law also recognise that there might be certain justifications for non-disclosure of materials used against the defendant in criminal proceedings, these are narrow restrictions, and commercial interests are not regarded as a valid justification for non-disclosure.111 Furthermore, EU law does not explicitly recognise any derogations from the right of access to materials that are essential to challenging the lawfulness of an arrest or detention.112 In order for Member States to comply with these standards, any exceptions to the disclosure of information regarding AI systems have to be applied very narrowly. Barriers to scrutiny and accountability of AI systems are not only legal, but also technical. As explained in previous sections, many AI systems suffer from interpretability issues because of their design and by the nature of the machine-learning technology upon which they rely. In the absence of specific expertise on AI, it is difficult to imagine how, in practice, defendants and their lawyers will be able to challenge AI systems. One possible solution to this challenge, as explained below, is training for defence lawyers – but it is unreasonable to expect lawyers to develop expertise that would enable them to analyse and scrutinise AI systems at a technical level. A further solution could be that defence lawyers have access to the relevant expertise from suitably qualified professionals. However, in reality, not all criminal suspects and accused persons are able to access the legal and other technical assistance needed to understand and challenge technically complex AI systems, for financial or other practical reasons. It would also be unreasonable and unrealistic to require all suspects and accused persons to engage technical expertise just to be able to understand how an AI system makes a decision, especially where AI systems are used routinely or mandatorily to make or assist criminal justice decisions. It might seem unreasonable to expect all highly technical evidence to be challengeable by lay defendants without the help of a suitable expert. However, AI systems are not necessarily used in criminal proceedings as ‘evidence’, and in practice they could be an integral part of a decision-making process, or even a replacement for it. As such, it is essential that the ‘reasoning’ of AI systems are made known to suspects and accused persons, similarly to how judicial decisions must contain “sufficient reasoning and address specific features of a given case”, especially where they concern the deprivation of liberty.113 Decision-making processes of AI systems and the way in which it has produced an outcome in a particular case should thus be disclosed to suspects and accused persons, in a form that is intelligible to a layperson. Individuals should not need to rely on experts to simply understand how a decision affecting them was made. While there will inevitably be scenarios where defendants would need expertise to challenge an AI-assisted decision, but these cases should be the exception, rather than the norm, for whenever an AI system is used. Criminal justice procedures should require the notification to suspects and accused persons where an AI system has been used which has or may have impacted a decision made about that individual. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is comprehensible to a layperson, without the need for technical or expert assistance, and suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training AI systems use technology not well understood by many people. Without proper training, outputs of AI systems might not be easy to interpret, and it might be difficult to appreciate which factors undermine the reliability of AI systems, so that appropriate weight can be attached to their findings. As mentioned above, decision-makers can be warned about the weaknesses of AI systems as part of their decision-making process, but the effectiveness of this safeguard can be questioned, because it is unlikely to provide decision-makers with all the information they need, and there is no guarantee that the warnings will be taken seriously in all cases. Training is not just needed for the primary users of AI systems, such as judges and police officers who use them to inform their own decisions. The training must also be available criminal defence lawyers, so that they are in a better position to challenge AI systems, where necessary. If AI systems are used routinely to aid criminal justice decisions or even made mandatory (as is the case in certain states in the United States), there would be strong justification for governing bodies to make training on AI mandatory for criminal justice practitioners. Part 3: Governance and Monitoring Criminal justice processes are an important enforcement mechanism for ensuring that AI systems are designed and used lawfully, but they cannot be the sole, or even the primary means of implementing legal and ethical standards. Of equal, if not greater importance is a framework that ensures that policy decisions on the design and deployment of AI systems are made in systematised way, and that unlawful or harmful AI systems never enter into public service. Member States that deploy AI systems for criminal justice purposes should have regulatory mechanisms that are fit for purpose. At a minimum, these should include frameworks for: a) pre-deployment impact assessments; b) post deployment monitoring and evaluations; and c) collection of data needed for effective comparative analysis. Pre-Deployment Both the GDPR and LED recognise the need for AI systems to be analysed before they are deployed, so that they comply with existing regulatory and human rights standards. Under Article 35 GDPR, Member States are required to carry out a ‘Data Protection Impact Assessment’ (‘DPIA’) for data processing systems that carry out ‘a systematic and extensive evaluation of personal aspects relating to natural persons which is based on automated processing, including profiling and on which decision are based that produce legal effects concerning the natural person or similarly significantly affect the natural person’. The corresponding provision in the LED is Article 27, which similarly calls for DPIAs to be carried out where processing of data is likely to result in a ‘high risk to the rights and freedoms of natural persons’. DPIAs under both laws have to carry out inter alia an assessment of the possible impact of the data processing system on the rights or individuals, and they need to mention what measures will be in place to ensure that their rights are properly protected. DPIAs help to address a serious accountability challenge, but EU laws do not provide sufficiently helpful standards on how they should be conducted. Article 27 LED does not lay down minimum requirements for how DPIAs should be carried out. On the other hand, there are aspects of Article 35 GDPR which, if used to guide how DPIAs should be conducted for AI systems used in criminal justice, would raise concerns. The foremost challenge is the level of transparency mandated by the GDPR. DPIAs are envisaged largely as internal processes led by the data controller, who may seek the opinions of data subjects (such as members of the public or their representatives), where it is ‘appropriate’ to do so. The GDPR also explicitly recognises that the requirement to seek the views of data subject is ‘without prejudice to the protection of commercial interests’.114 As outlined above, transparency is a key aspect of a fair criminal justice system and, as a general rule, all criminal justice decision-making processes need to be open to public scrutiny. There is no reason why AI systems should be exempt from this requirement and, given that administration of criminal justice is a matter of strong public interest, the public should have the right to voice their opinions and raise objections whenever AI systems impact criminal justice processes. Also, given the highly technical nature of AI systems, and their (as yet) poorly understood impact on society, impact assessments must have multi-disciplinary expert engagement. 115 In particular, DPIAs should always involve independent experts (computer scientists, in particular) who can audit, analyse, and if possible, ‘explain’ AI systems, so that they can help legal, policy and social science experts to determine the likely implications for the individuals’ rights. For public and expert consultations to be meaningful and effective, sufficient information should be made available to interested parties so that the AI system can be thoroughly understood and researched. Partnership on AI has recommended that for criminal justice risk-assessment tools, training datasets,116 architectures and algorithms of AI systems should be made available to ensure meaningful scrutiny.117 Commercial interests should not be regarded as a legitimate ground for limiting the disclosure of this information. Secondly, Article 35 GDPR allows data controllers to carry out a single DPIA ‘for a set of similar processing operations that present similar high risks’. There is a danger that this provision could be interpreted too broadly if Member States are given free rein to determine what two systems can be regarded as sufficiently ‘similar’. There are risks in assuming that an AI system well-suited for use in a particular context or within a particular geographic area will be equally useful in another. AI systems built using data from one jurisdiction might not be able to reflect differences in, for example, law enforcement culture and patterns of behaviour, laws and policies, and socio-demographic characteristics of another jurisdiction.118 Sometimes, these differences can be seen in the same country or even within the same region. For example, a study of ‘PRECOBS’ a predictive policing tool used in Baden-Wurttemberg in Germany, found significant differences in predictive utility between rural and urban areas.119 Finally, DPIAs seem to require data controllers to theorise the possible impact of AI systems, but there is no strict requirement for AI systems to be subject to testing or auditing before, or immediately after deployment. This overlooks the fact that flaws in AI systems, including unintentional biases, are not always easily detectable, and that they might only surface once the system is put into operation. As discussed earlier, the causes of biases in AI systems can be difficult to identify, and it is difficult to appreciate how, short of thorough testing, the true impact of AI decisions can be known. In New York, the AI Now Institute has proposed an alternative model for impact assessments, known as ‘Algorithmic Impact Assessments’ (‘AIAs’).120 The AIA framework sets out in detail how public authorities should conduct impact assessments of AI systems, and it can be contrasted with the provisions of the GDPR in that AIAs place much greater emphasis on the need for community engagement and consultations with external experts. This framework could serve as a useful guide for Member States seeking to establish pre-deployment procedures for approving AI systems. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. AI systems must be tested for impact pre-deployment, and systems should be precluded from deployment until they have undergone this testing and achieved minimum standards, such as non-discrimination. Post-Deployment Impact assessments of AI systems should not be regarded as ‘one-off’ processes. They have to be followed up with ongoing post-deployment monitoring and evaluation, so that the longer-term impact of AI systems can be understood, and shortcomings and biases that affect the rights of individuals can be identified and fixed. The ability of AI systems to deliver fair and just outcomes, and to meet policy objectives can be difficult to predict from the outset. Although AI systems can be validated and tested prior to deployment to check if they are likely to produce desired outcomes, their impact in the real world might be different. Furthermore, even if the likely outputs of AI systems can be predicted, it is much harder to estimate the likely impact they will have on human decision-making.121 Further reviews of AI systems are also necessary because criminal justice systems and the societies in which they operate change over time. A study in the United States, for example, theorises that many pre-trial risk assessment tools might be making predictions based on historic data that is no longer fit for purpose. It has been suggested that because data used to train risk assessment algorithms pre date bail reforms in many US jurisdictions, the impact of recent measures introduced to reduce the risk of failure-to-appear, such as transportation assistance and text message alerts are not taken into consideration – potentially leading to over-incarceration.122 Socio-demographic changes might also require AI systems to be altered so that they continue to be fit for purpose. If, for example, an area experiences high levels of net migration which results in rapid changes to policing patterns and judicial behaviour, AI systems might need to be reviewed to make sure they are not unintentionally worsening racial discrimination. Data Collection It is difficult to imagine how the impact of AI systems can be assessed, if there is inadequate data to support effective monitoring. The deficiency of criminal justice data across the EU has been subject to criticism. In particular, Fair Trials has found that most EU Member States do not systemically collect statistics on the duration of pre-trial detention, outcomes of criminal cases of pre-trial detainees, and the likelihood of a suspect or accused person being released by the court.123 The data needed for effective monitoring and evaluation depends on the function of the AI system and its intended objectives, but the lack of criminal justice data more generally questions whether Member States currently have adequate legal and policy foundations for introducing AI systems responsibly into criminal justice processes. Data needed for monitoring and evaluation purposes will, of course, need to have been collected from well before the introduction of the AI system, so that a proper pre- and post- analysis comparison can be made. Of particular concern is that in most EU Member States, race or ethnic data on criminal justice is not available, either because there is no systemised process for collecting it, or because local laws ban this practice altogether.124 This is a serious challenge because the most predominant criticism against the use of AI systems in the United States and elsewhere is that it worsens racial and ethnic bias in criminal justice decisions. Even without official statistics, there is strong evidence in many EU Member States that certain ethnic minorities, and in particular, Roma and people of colour are unfairly overrepresented in criminal justice systems.125 It is worrying that AI systems might worsen this discrimination, but that there will be no way of detecting this trend, because of the lack of data. Furthermore, the absence of racial and ethnic data could also prevent pre-emptive measures to combat racial bias. It is doubtful that developers will be able to design systems free from racial bias, if they have no data against which to measure their performance. On data collection, Fair Trials believe that EU and its Member States will need to make a strict choice. Either they should ensure that racially disaggregated criminal justice data is collected, or AI systems should be banned where they make individualised assessments for criminal justice purposes. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity.
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Answer the following question using only details found in the attached paper. You should NOT reference outside sources or your own knowledge. What are some examples of visible and hidden biases that have been observed in criminal justice AI? Executive Summary ‘Artificial Intelligence’ (‘AI’), comprising machine-learning and other analytical algorithm-based automated systems, has become an important aspect of our lives. In recent years, this technology has been increasingly deployed in criminal justice systems across the world, playing an increasingly significant role in the administration of justice in criminal cases. This trend is often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost savings in policing and court services. However, studies in various jurisdictions, including in Europe, provide substantial evidence that AI and machine-learning systems can have a significantly negative influence on criminal justice. AI systems have been shown to directly generate and reinforce discriminatory and unjust outcomes; infringing fundamental rights, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design that does not comply with human rights standards. Most AI systems used in criminal justice systems are statistical models, based on data which is representative of structural biases and inequalities in the societies which the data represents, and which is always comprehensively lacking in the kind of detail that is needed to make truly ‘accurate’ predictions or decisions. The data used to build and populate these systems is mostly or entirely from within criminal justice systems, such as law enforcement or crime records. This data does not represent an accurate record of criminality, but merely a record of law enforcement - the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data reflects social inequalities and discriminatory policing patterns, and its use in these AI systems merely results in a reinforcement and re-entrenchment of those inequalities and discrimination in criminal justice outcomes. Given these extremely serious risks, strong regulatory frameworks are needed to govern the use of AI in criminal justice decision-making and, in some circumstances, to restrict its use entirely. Existing EU data protection laws restrict the use of automated decisions, but there are gaps and ambiguities that could result in the use of AI systems in ways that undermine human rights, if not accompanied by further guidance or legislation. Firstly, EU laws currently only prohibit decisions that are solely based on automated processes, but they do not regulate decision-making processes that are largely dependent on automated systems. Given that most AI systems in use today are designed and deployed to assist, rather than replace, human decision-making in criminal justice systems, they largely fall outside the remit of EU data protection laws on automated decisions. Secondly, the prohibition on automated decisions is subject to broad exceptions. Individuals can be subject to decisions based solely on automated processes if authorised by EU or Member State law, and there are deemed to be appropriate human rights safeguards in place, including the right to obtain human intervention. However, there is not enough clarity on what safeguards are needed, and how ‘human intervention’ should be interpreted. In order to regulate the use of AI in criminal justice proceedings, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. The design of AI systems and their deployment in criminal justice proceedings should be regulated to generate human rights compliant, non-discriminatory outcomes. Minimum standards and safeguards should be set, which, if they cannot be adhered to, should preclude the use of the AI system in question. AI should also be regulated so that they are sufficiently transparent and explainable to enable effective independent scrutiny. AI systems should be designed and deployed to comply with and give effect to inter alia the right of access to court, the right to be presumed innocent, and the right to liberty. AI systems should not undermine the right to be tried by an impartial and independent tribunal and, in line with existing EU laws, no individual should be subject to an automated decision that results in a criminal record. AI systems should be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure that they have the desired effect of reducing pre-trial detention rates. AI systems must be developed to guarantee that they do not generate discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race, ethnicity, nationality or socioeconomic background. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. AI systems which cannot adhere to this minimum standard should have no place in the criminal justice system. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, and the general public. Commercial or proprietary interests should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decisions made against them. It should be possible to carry out an independent audit of each AI system, and its processes should be reproducible for that purpose. Member States should have laws that govern how AI systems are relied upon in criminal proceedings, and there must be adequate safeguards to prevent over-reliance on AI by decision-makers, to prevent discrimination and to ensure scrutiny and effective challenge by the defence. Procedural safeguards should actively tackle automation-bias amongst criminal justice decision makers. Examples include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easy for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. Criminal justice procedures should ensure that defendants are notified if an AI system has been used which has or may have influenced a decision taken about them at any point in the criminal justice system, from investigation to arrest, from charge to conviction, and sentence. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is clear and comprehensible to a layperson, without the need for technical or expert assistance, in order to ensure fairness, equality of arms, and to discharge the obligations to provide all relevant information and be given reasons for decisions under the right to a fair trial. Suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training should be made available to all primary users of AI systems, and to criminal defence practitioners, so that there is greater awareness of AI technology, and of the risks of over-reliance on AI. Effective regulation of AI systems should be facilitated by a governance and monitoring framework. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. A requirement of the assessment should be a consideration of whether it is necessary to use AI in the particular use case, or whether an alternative solution could achieve the same aims. As far as it is possible to do so, AI systems should also be tested for impact pre-deployment, a part of which should be the minimum requirement to prove that the AI system has no discriminatory impact, either directly or indirectly, before it can be deployed. AI systems should be kept under regular review post-deployment. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity. Background Rapid technological advancements in recent years have made artificial intelligence (‘AI’) an increasingly prominent aspect of our lives. There are differences of opinion as to the definition of AI and its true meaning, but for the purposes of this paper we are broadly referring to automated decision-making systems based on algorithms, including machine-learning, which are used in the criminal justice system. There is little doubt that AI has great capacity to increase human potential and improve the lives of many, but the increasing role of AI in assisting important public functions has also highlighted serious risks and challenges. If not subject to proper regulation and oversight, AI can threaten fundamental human rights and, far from expanding human potential, it can amplify and worsen harmful aspects of our society, including inequality and injustice. This challenge is particularly evident where AI has been used to assist the administration of justice in criminal cases. In recent years, more and more jurisdictions across the world have begun to use AI technology to inform and assist policing and judicial decisions, often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost-savings in policing and court services. In some countries, algorithmic processes can influence which geographic neighbourhoods should be subject to increased law enforcement and when, as well as which individuals should be specifically targeted by law enforcement. They can help to determine whether someone should be arrested, whether they should be charged with a criminal offence, whether they should be detained in prison before trial and, if convicted and sentenced, the length of their sentence. AI is being used more and more to influence highly sensitive, high impact decisions that have far reaching, long-term implications for individuals’ rights. Research emerging from the United States, where the use of AI in criminal justice is particularly widespread, and from the United Kingdom and some EU Member States, however, seriously questions whether AI has a positive influence on criminal justice systems. AI tools and systems have been found to actively generate discriminatory criminal justice outcomes, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design, that does not reflect or give effect to human rights standards. These criticisms might not be justified for all AI systems, but these studies highlight the need for much stronger regulatory frameworks to govern the use of AI. We believe that unless it is subject to robust regulation, it is unlikely that AI can be used in criminal justice systems without undermining the right to a fair trial. In some cases, it should be restricted from use entirely. EU Member States should be encouraged to take a much more cautious approach to AI and subject automated processes to more stringent rules that are designed to ensure human rights compliance. There is the potential for AI systems, if properly and robustly regulated, to have a positive impact on criminal justice system, advancing human rights, for example, by analysing law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination. The EU is already a world leader on AI regulation, having adopted ground-breaking data protection laws in recent years to shield individuals from automated decisions that have an adverse effect on their rights. We welcome the EU’s commitment to build further on existing legal standards, and we emphasise that addressing the impact of AI on criminal justice has to be a primary consideration for EU policy makers when deciding on appropriate legal standards. Discussions around the impact of AI on human rights have largely been centred on data protection, the right to privacy, and broader questions of ethics and human dignity. However, despite the increasing use of AI systems in criminal justice systems across the world, only limited discussions have so far focused on how these systems impact the right to a fair trial, and what regulations are needed to address that impact. About this paper Fair Trials has produced this policy paper to highlight the need for EU-wide standards on the regulation of AI in criminal justice, and to inform EU policy makers about the standards and safeguards needed to ensure effective protection of fair trial rights where criminal justice decisions are assisted by AI. The EU Commission recognised that AI represents risks for fundamental rights, including the right to a fair trial, in its 2020 White Paper, ‘On Artificial Intelligence – A European approach to excellence and trust’. It also recognised the need for improvements to the EU’s legislative framework on AI, noting in particular the challenges in the ‘effective application and enforcement of existing EU and national legislation’ and the ‘limitations of scope of existing EU legislation’. In this paper, we identify the most common fair trial rights issues raised by existing AI systems, based on examples and experiences from the EU, the United Kingdom, and the United States. We also offer examples of practical legal and policy solutions that could help to address these challenges, and to assist in the effective implementation of the EU’s fundamental rights standards in this area. We recognise that the use of AI has a broader impact on human rights beyond the right to a fair trial, and that there are important social and ethical issues that also need to be addressed. However, we have narrowed the focus of this paper given Fair Trials’ mission and field of expertise. This paper should not be treated as an exhaustive list of fair trial rights standards that need to be introduced. AI is used in many ways in criminal justice systems cross the world and, as the technology continues to develop, it is likely that we will eventually see the deployment of AI technology in ways never imagined before. This paper focuses primarily on AI systems that carry out individualised risk assessments, given that these types of systems have had the most significant impact on individuals’ rights so far, and we envisage that similar systems will become increasingly common in the near future. Existing EU Legal Framework Existing EU laws restrict the use of automated decisions in a wide variety of contexts. Article 22 of the General Data Protection Regulation (‘GDPR’) provides that data subjects have the right not to be subject to decisions ‘solely’ based on automated processes, where they produce ‘legal effects’ concerning them, or where they ‘similarly significantly affect’ them. The Law Enforcement Directive (‘LED’) – the EU data legislation that governs the processing of data for criminal justice purposes – has a very similar provision at Article 11, which requires Member States to prohibit decisions based solely on automated processing, where they produce ‘adverse legal effects’ on the individual, or effects that are ‘similarly significant’. However, there are two notable gaps in the existing legislative framework governing automated decision-making systems under both the GDPR and the LED. These ambiguities and potential loopholes could be exploited in ways that seriously undermine the general prohibition of automated decision-making processes, and adversely impact human rights. It is necessary, therefore, that the EU provides further guidance on how these provisions should be interpreted, including thorough legislation (if appropriate) to further clarify the circumstances in which Member States are allowed to deploy AI systems for criminal justice proceedings. Firstly, the provisions in the GDPR and LED only prohibit decisions based ‘solely’ on automated processes. In other words, the laws regulate the impact of decisions made through automated processing, but not the AI systems themselves. As discussed later in this paper, the main human rights challenges of AI systems can be attributed to how they are designed and trained, and the types of technology used, such as machine-learning, so it is crucial that decisions about the design and deployment of AI systems are also regulated. Secondly, neither the GDPR or LED provide regulatory standards to govern situations where automated processing is not the ‘sole’ basis of a decision, but a primary influencer. In reality, the difference between a fully automated decision and a decision made with a ‘human-in-the-loop’ is not always clear, but because of this strict classification, AI systems are able to be used and have significant legal effects without the corresponding safeguards. Stronger legal standards are needed to make sure that semi-automated decision-making processes do not become de facto automated processes. Thirdly, the prohibition on automated decision-making is subject to two very broad exceptions. Automated decisions are prohibited under the GDPR and LED, ‘unless authorised by Union or Member State law’ and there need to be ‘appropriate safeguards for the rights and freedoms of the data subject, at least the right to obtain human intervention’.1 These provisions give extremely wide discretion to Member States to override the general prohibition. It is significant that EU laws emphasise the need for human rights safeguards, and the need to ensure the possibility of human interventions, but neither of these concepts have yet been adequately defined. Although influential actors like the EU and the Council of Europe have established principles on the ethical and responsible use of AI, there is currently no authoritative guidance on the practical safeguards that need to be in place.2Likewise, the meaning of ‘human intervention’ is open to interpretation. LED provides some guidance on who should be carrying out the human intervention,3 but there needs to be greater clarity on what meaningful human intervention entails in different contexts. In order to regulate the use of AI in criminal justice proceedings, and close the gaps in existing data protection laws, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. Part 1: Regulating the Design and Deployment of AI Systems in Criminal Justice Systems AI systems deployed to assist criminal justice decision-making have to be fit-for-purpose. The purposes of AI systems differ depending on the context in which they are deployed, but there are a few common considerations that need to be taken into account to determine whether it is appropriate for the AI system to be used. Firstly, AI systems have to be designed to produce outcomes that are desirable from a human rights and non-discrimination perspective. This means that rather than being exclusively focused on delivering ‘accurate’ outcomes in criminal cases, AI systems have to be designed to facilitate fair, impartial and non-discriminatory criminal processes. Developers of AI systems and public entities that commission them should, in particular, make sure that AI systems are consciously designed to give effect to, and promote the right to fair trial. The fundamental issues with the way AI systems are designed and built, resulting in discriminatory outcomes, must also be considered. Given the significant evidence of AI systems influencing discriminatory outcomes, special efforts must be made to ensure that AI systems do not produce discriminatory outcomes. Secondly, AI systems need to be designed in a way that makes it possible for criminal defendants and the broader public to scrutinise them. This means that AI systems should not only be made open to scrutiny (rather than concealed to protect commercial interests), but their inner workings and processes should also be discernible and comprehensible. AI Systems should be designed to protect and promote the right to a fair trial Where AI systems are used to assist or inform criminal justice decisions, they support an important act of public administration that has a significant impact on the rights of suspects and accused persons. AI systems do more than just provide outputs that decision-makers can take into consideration as evidence. By attempting to mimic human analytical processes and reasoning, they can provide influential advisory input into human decision-making, or even replace it altogether. As such, it is right that human rights standards that govern criminal justice decision-making also apply to AI systems. The Council of Europe and the EU Commission’s High Level Expert Group on Artificial Intelligence (‘AI HLEG’) have both recognised that fundamental rights should be a key guiding principle for the design and deployment of AI systems.4 The Council of Europe recommends that AI systems are built according to ‘human rights by design’ principles, and recognises that AI systems should not undermine the right to a fair trial under the European Convention on Human Rights (‘ECHR’). The AI HLEG has similarly recognised that the respect for fundamental rights, as enshrined in the EU Charter of Fundamental Rights and international human rights instruments, should form the foundations of trustworthy AI. AI HLEG’s Ethics Guidelines for Trustworthy AI (‘the Ethics Guidelines’) also recognise the need for AI systems to comply with other types of EU legislation. Although not mentioned explicitly in the Ethics Guidelines, Fair Trials would emphasise that the design of AI systems and the ways in which they are deployed in the EU should, in particular, be compatible with the standards set out in the procedural rights directives under the ‘Roadmap for strengthening procedural rights of suspected or accused persons in criminal proceedings’.5 We would also like to note the potential for AI systems to have a positive impact on criminal justice systems. Public debate about the relationship between AI and human rights have predominantly been centred on the idea that AI is a threat to human rights. It is equally important, as technology takes an increasingly prominent role in public life, to consider what positive potential they may have. Policy makers, developers, civil society activists, and other stakeholders should try to identify ways in which AI can also play an active role in advancing human rights, and improve the fairness of criminal justice systems. For example, AI systems could be used to analyse law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination, for preventative purposes. AI systems which are used as part of criminal justice decision-making should be designed not just to ensure that they do not undermine the right to a fair trial, but also to promote it. However, as explained below, given the embedded biases in the criminal data used to develop and train AI systems, there are serious doubts, based on recent studies, whether AI systems can promote fair criminal justice at all. There are various aspects of the right to a fair trial and, without speculating on what kind of AI systems will be developed in the future to support criminal justice decision-making, it is difficult to articulate how fair trial rights standards should inform the design of AI systems. However, examples of AI systems currently deployed in the EU and elsewhere suggest that there are certain aspects of the right to a fair trial that require special attention. These are: a) the right of access to court b) the presumption of innocence; c) the principle of the equality of arms; and d) the right to liberty. Access to Court The notion of AI systems replacing courts to determine the guilt or innocence of the accused may seem far-fetched at present, but there is a growing trend of automated administration of justice across the world that might threaten the right of access to court. For example, in several European countries, speeding and other minor traffic offences have been detected and enforced by means of automated processes for more than a decade.6 Although nominally criminal processes, these types of proceedings are, in reality, normally administrative in nature, and they rarely have a ‘significant’ impact on the rights of individuals. However, as surveillance technology develops, thanks to AI, there is a real likelihood that the scope of crimes punishable by way of automation will increase.7 In the United Kingdom, the government announced plans in 2017 that would enable defendants to enter guilty pleas via an online portal after viewing the charges and evidence against them, for a small number of minor offences.8 Under this procedure, known as ‘automatic online conviction’, defendants would be automatically convicted and fined without any judicial oversight if they accept the charges against them. Although it is debatable whether this system can truly be characterised as an AI system, it is an example of the automated administration of criminal justice, that replaces a function usually played by courts. It is worrying that the UK government has proposed expanding this scheme to other ‘non imprisonable’ offences, if itis regarded as a success.9Fair Trials has outlined concerns about expanding the scope of cases where accused persons can be convicted without judicial oversight, even if such procedures are reserved solely for minor, non-imprisonable offences.10 The impacts of a criminal conviction, even for a minor offence, can be numerous, long-term, and hard to predict, affecting inter alia job prospects, educational opportunities, and immigration status. It is crucial that what amounts to ‘legal effects’ and ‘similar significant effects’ concerning the data subject for the purposes of automated decision-making are interpreted very broadly.11 In particular, given that a criminal record always has a ‘legal’ or ‘significant’ effect, any automated decision-making process that directly results in a criminal record should be prohibited. AI systems should not undermine the right to be tried by an impartial and independent tribunal, and in line with existing EU laws, no individual should be subject to an automated decision that resultsin their being held in custody or detention, gives them a criminal record, or which determines a criminal sentence or sanction. No individual should be subject to an automated decision which engages their human rights without meaningful human input. Presumption of Innocence The right to be presumed innocent in criminal proceedings is a basic human right, and one that is expressly recognised in, and safeguarded by EU law under Directive 2016/343 (the ‘Presumption of Innocence Directive’).12 The increasing use of AI in the sphere of criminal justice, however, raises questions about the scope of this right, and how AI systems should be built and used to protect it. Concerns about how AI systems undermine the presumption of innocence have been voiced in the context of certain types of predictive policing software.13 A variety of predictive policing tools that aim to facilitate preventative policing measures and to deter crimes before they have taken place have been developed and deployed across Europe.14 Tools which predict the time and place where certain crimes are likely to take place have been used in many European countries. Similar tools have also been developed to identify potential suspects, which are used widely in the US, and now increasingly in Europe.15 An example is the ‘Strategic Subject List’ in Chicago, a police database of around 400,000 local residents who were assigned threat scores that determine the likelihood that they will commit crimes.16 The algorithms used to generate these scores were not open to the public, so the exact process by which individual risk levels were assessed were not known. Despite this lack of transparency, it is clear that threat scores generated by the software had significant impacts on individuals’ rights – in particular, their right to privacy. Individuals with higher threat scores were, for example, more likely to be subject to targeted police surveillance, or home visits – as though they were officially recognised as predisposed to commit crimes, irrespective of any credible suspicion of wrongdoing.17 The Strategic Subject List was decommissioned in January 2020 by the Chicago police who cited ineffectiveness as the primary reason for the decision.18 These types of predictive policing tools are now being used in Europe. In the United Kingdom, a coalition of police forces have been developing a system not dissimilar to the Strategic Subject List, that aims to identify individuals who are likely to commit crimes.19 Known as the National Data Analytics Solution (‘NDAS’), this risk assessment tool uses statistical analysis and machine-learning to inform policing decisions, and to facilitate ‘early interventions’ where appropriate.20 The sources of data that the system uses to conduct its risk assessments raise concerns that the system will be built to profile individuals on the basis of very sensitive, personal information, including stop and search data, data from social services, and the National Health Service.21 Where this data is used to indicate the likelihood of individuals’ criminality, it will inevitably flag up people whose profiles fit those who are over-represented in that data as being higher risk. It is particularly worrying that an individual might be profiled for policing purposes on the basis of their health conditions or their access to essential services, such as welfare or benefits. These factors should not be regarded as relevant factors for determining whether someone may commit criminal offences. Also in the UK, the Metropolitan Police in London operates a database called the Gangs Matrix, which contains information and risk-assessments on individuals who are alleged ‘gang’ members.22 This database was created using criminal justice data, including police and crime records. The Gangs Matrix and the assessments it produces assists policing decisions, including the deployment of stop and search, and further enforcement action, such as imprisonment and deportation. A further tactic resulting from the risk assessments made by the Gangs Matrix is the threat of eviction or exclusion from education, as names and details of these alleged gang members have been shared with education, healthcare and housing providers.23 In the Netherlands, the government has been running an algorithmic risk assessment tool, ProKid 12- SI, which purports to assess the risk of criminality of 12-year-old children since 2009.24 ProKid uses existing police data on these children, such as reports of where children have come into contact with the police, their addresses, information about their ‘living environment’, even including whether they are victims of violence, to identify them as being in one of four categories of ‘risk’ of committing crimes in future.25 The system assesses children based on their relationships with other people and their supposed risk levels, meaning that individuals can be deemed higher risk by being linked to another individual with a high risk assessment, such as a sibling or a friend.26 Parents’ assessed risk can also impact a child’s risk level. ProKid’s algorithms assess risks in relation to future actions that the children have not yet carried out, and judges them on the basis of the actions of others close to them.27 These risk assessments result in police ‘registering’ these children on their systems and monitoring them, and then referring them to youth ‘care’ services.28 ProKid frames children as potential perpetrators even when they are registered as victims of violence; which has serious implications on their presumption of innocence.29 Several similar tools are also used in the Netherlands, including the Reference Index for High Risk Youth, a large-scale risk assessment system that focuses on assessing under-23-year-olds.30 Predictive policing tools like NDAS, ProKid and the Gangs Matrix can be regarded as part of a broader trend in law enforcement that moves away from ‘reactive’ policing, and towards ‘preventative’ or ‘proactive’ policing.31 NDAS and other similar predictive policing tools intend to pursue legitimate objectives of preventing, or reducing harm,32 but there are serious concerns that these systems single out individuals as ‘pre-criminals’, who are subject to police interventions even though they are not formally suspected of any crime, and there is no evidence that they have done anything wrong.33 It is of further concern that these types of predictive policing tools do not necessarily designate individuals’ risk levels on the basis of their past actions, or behaviour that can be regarded as ‘suspicious’ in any way, but on account of factors far beyond their control, and immutable characteristics. In particular, there is strong evidence to suggest that AI systems have a tendency to overestimate the risks of criminality of certain ethnic and racial groups. For example, out of 3,800 people on the Gangs Matrix, 80% are 12-24 years old, and 78% of them are black – a clearly disproportionate and discriminatory proportion. The discriminatory impact of AI in criminal justice systems is discussed in further detail in the following section. Although predictive policing tools do not directly ‘convict’ people, they not only allow the police to treat legally innocent individuals as pseudo-criminals, but they can also result individuals being deprived of their basic rights with regard to education, housing, and other public services – effectively ‘punishing’ them on account of their profiles. This seriously damages the fundamental human rights principle that the matter of guilt or innocence can only be determined by means of a fair and lawful criminal justice process.34 While it is clear that certain types of predictive policing can infringe the presumption of innocence from a moral and ethical viewpoint, it is debatable whether these systems also violate the legal presumption of innocence under EU law and international human rights law. The Presumption of Innocence Directive applies to natural persons who are ‘suspects’ and ‘accused persons’, from the moment they are suspected or accused of a crime.35 However, there is some ambiguity about the exact stage at which an individual attains the status of a ‘suspect’ under the Presumption of Innocence Directive,36 and about whether the scope of the Presumption of Innocence Directive extends to decisions to designate an individual as a suspect (or a ‘pre-criminal’). On the other hand, the ECHR appears to have taken a clearer position that measures undertaken pre-charge, as a general rule, fall outside the scope of the presumption of innocence.37 It has also held that preventative measures, such as surveillance, do not amount to criminal sanctions for the purposes of Article 6 ECHR.38 Even if the current language on the presumption of innocence is such that it is not directly applicable to the predictive policing context, it must be recognised that these tools nevertheless interfere with human rights. In particular, the targeted surveillance that results from predictive policing has clear implications on the right to privacy. The acceptable degree to which criminal justice processes can interfere with this right is a matter that might require clearer articulation, as is the question of the impact of Article 8 ECHR violations on criminal proceedings. AI systems that inform charging decisions have also been developed and deployed. An example of this is the Harm Assessment Risk Tool (‘HART’) currently being used by Durham Constabulary in the United Kingdom. HART uses a machine-learning algorithm to assess a suspect’s risk of reoffending, using over thirty variables that characterise an individual’s criminal history and socio-demographic background. The risk assessments conducted by HART are used by the local police to determine whether an individual should be charged, or diverted into a rehabilitation programme. HART does not determine whether an individual is guilty or innocent, but its assessment can trigger a chain of events that can result in the deprivation of liberty, and/or a criminal conviction. Charging decisions should surely be based on the merits of individual cases, and it is difficult to imagine how decisions on entry into diversion programmes can be made by means other than a careful consideration of individual circumstances. These types of high impact, fact-sensitive decisions should never be delegated to automated processes, particularly those which operate by identifying correlations rather than causal links between an individual’s characteristics and their likely behaviour. An examination of HART also reveals flaws in how the tool is designed. HART is calibrated to err on the side of caution,39 because it regards under-estimations of risk levels as a more serious error than over-estimations, so that under-estimations occur less frequently. In other words, HART is deliberately designed to underestimate who is eligible for entry into the diversion programme, so it is predisposed to over-criminalise. This approach conflicts with the notion that any doubt in a criminal case should be interpreted in favour of the defendant (‘in dubio reo’).40 A human rights compliant approach to criminal justice decision-making would do the opposite of what HART does – it would need to err on the side of the defendant. AI systems should respect the presumption of innocence and they must be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow or assist the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Equality of Arms A major concern raised in the studies of certain AI systems is that they are inaccessible for adequate scrutiny by defendants and their lawyers. This has serious implications for the principle of equality of arms and the right to an adversarial process, because without information about how a decision is made, it is difficult to envisage how defendants can question the accuracy and legality of the decision. The need for AI systems used in criminal justice to be transparent, explainable and understandable to all is addressed in more detail below. The Right to Liberty In the United States, ‘risk-assessment’ tools that use AI technology have been used to assist pre-trial assessments that determine whether a defendant should be released on bail, or held on remand pending their trial. Examples of risk-assessment tools currently being used in the United States include COMPAS, the Public Safety Assessment (‘PSA’), and the Federal Pre-Trial Risk Assessment Instrument (‘PTRA’). Many of these tools are also used to inform decisions on parole and sentencing. These tools have, however, been subject to intense criticism for several reasons. Studies have shown inter alia that risk assessments make inaccurate predictions that are no better than those made by non-expert humans. They do not result in a significant reduction in pre-trial detention rates, and that they produce disparate outcomes for different racial groups. The US-based NGO Partnership on AI has found that AI risk assessment tools currently being used in the United States are unfit for use in pre trial assessments, and it has recommended that policymakers cease the deployment of risk assessment tools until such time that the challenges affecting such tools have been adequately addressed.41 The adoption of pre-trial risk-assessments tools in the United States has largely been driven by the desire to address high imprisonment rates in the country by making pre-trial decision-making fairer. In particular, these tools have been promoted as an alternative to cash bail – a system often criticised for disadvantaging poorer defendants and worsening social injustices.42 Cash bail is a relatively rare concept in the EU, but there are concerns about the quality of pre-trial detention decisions in many Member States, which have been criticised for failing to carry out case-specific reviews and fully consider alternatives to detention.43 We are currently unaware of any attempts in EU Member States to introduce algorithmic risk assessments to supplement or replace existing pre-trial decision-making processes. However, it is possible that risk-assessment tools will also be recommended as a solution to address the pre-trial detention challenge in Europe, especially given that many of these tools are developed by private companies that actively market their products to governments and local police forces. Risk-assessment tools are usually designed to assess the likelihood of re-arrest, and/or of failure to turn up to court after being released based on the profiles of the defendant. Based on these assessments, risk assessment tools either assign risk levels to defendants, or they provide direct advice to decision-makers on whether or not the defendant should be released. There is only limited research about the extent to which pre-trial risk-assessment tools influence judges’ decisions in practice,44 but concerns have been raised about the ability of AI systems to recommend detention at all.45 There is a risk that recommendations made by AI systems to detain individuals compromise the presumption of release. This is a particularly valid concern in light of research suggesting that decision-makers have a tendency to err on the side of caution when they are ‘advised’ by AI systems, and that they have a greater propensity to override risk assessment tools to detain, rather than release defendants.46 Pre trial detention should always be a measure of last resort, and no risk-assessment can be regarded as human rights compliant, unless it recommends its users to consider detention as a measure of last resort, after all other alternatives have been fully considered. Pre-trial risk assessment tools in the United States and elsewhere have also been criticised for (unintentionally) over-estimating risks, because of the nature of the data used to train its algorithms. Pre-trialrisk assessment tools typically rely only on data regarding individuals who have been released, and they ignore those who were detained, but would have otherwise ‘succeeded’ by not being arrested, and by appearing in court.47 In other words, algorithms are based on the assumption that individuals who have been detained by courts in the past have been rightfully deprived of their liberty. Any AI system developed to assist pre-trial detention decision-making must be designed to give effect to the presumption in favour of release. This means that risk-assessment tools need to be deliberately calibrated to generate outcomes that favourable to the defendant. Data used to train the AI system should be carefully scrutinised so that it reflects the inevitable fact that a significant proportion of individuals in pre-trial detention have been deprived of their liberty in violation of their human rights. Studies of pre-trial risk-assessment tools used in the United States cast doubt on their effectiveness at reducing pre-trial detention rates, and their ability to make accurate predictions of risks. A study in Kentucky, for example, found that the likelihood of defendants being released within the first three days of their arrest went down after the risk-assessment tool was deployed, and that there were no significant changes in the number of re-arrests and failure-to-appear rates amongst defendants released on bail during the same period.48 This was the case even after the risk-assessment tool was modified post-deployment to improve the accuracy of predictions. Another study has found that the COMPAS risk-assessment tool is no better at predicting the likelihood of defendants reoffending than non-expert human volunteers.49 These studies do not necessarily prove that AI systems are incapable of reducing pre-trial detention rates at all, but they do raise questions about their usefulness, and they strongly challenge claims that algorithmic risk-assessment tools help to improve the quality of pre trial detention decisions. They also highlight the need for post-deployment testing and monitoring of AI systems, to ensure that they have the desired effect of ensuring that individuals are detained only as a measure of last resort. Post-trial assessment systems are also being increasingly used, for purposes such as assisting with sentencing decisions or prisoner release. In England and Wales, the Prison and Probation Service has developed and operates the Offender Assessment System (OASys), an automated risk-assessment tool.50 It assesses the risk of harm offenders pose to others and how likely an offender is to reoffend, as well as assessing offender needs. These risk assessments are used to decide ‘interventions’ and to influence the sentence plans given to offenders.51 Millions of these assessments have been carried out.52 The system collates information on offenders’ previous offences, education, training, employment, alcohol and drug misuse; as well as their ‘attitudes’, ‘thinking and behaviour’, ‘relationships’, and ‘lifestyle’.53 This data is used alongside the individual’s offending record and ‘offender demographic information’ to inform two predictive algorithms: OASys General Reoffending Predictor (OGP1) and OASys Violence Predictor (OVP1).54 A 2014 National Offender Management Service analysis found that the OGP1 and OVP1 generated different predictions based on race and gender. They found that relative predictive validity was better for white offenders than for Asian, black, or mixed ethnicity offenders. The Offender Group Reconviction Scale (OGRS) is another algorithmic risk assessment tool, which is used in England and Wales to assess and predict an offender’s likelihood of reoffending.55 The OGRS algorithm uses data on the individual’s official criminal history, as well as their age and gender, to produce a risk score between 0 and 1 of how likely an offender is to reoffend within one or two years. The use of these AI systems in a post-trial setting, and the documented differences in predictive outcomes based on, among other factors, race, highlight the clear need for strict testing and monitoring of such systems. These systems used in a post-trial setting could very easily be transferred to a pre-trial risk assessment setting; the principles and aims of these systems and the data used are very similar. For example, the COMPAS system, mentioned above and considered in more detail below, was originally designed as a recidivism risk assessment tool, and is also used as a pre-trial risk assessment tool. 56 Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure they have the desired effect of reducing rates of pre-trial detention rates. AI systems should be designed to be non-discriminatory One of the most frequent criticisms of AI systems and their use in criminal justice systems is that they can lead to discriminatory outcomes, especially along racial and ethnic lines. The best-known example of this is a study by the US media outlet ProPublica into COMPAS, a risk assessment tool designed to predict the likelihood of reoffending in Broward County in Florida. ProPublica found that COMPAS was 77% more likely to rate black defendants as ‘high-risk’ than white defendants, and it was almost twice as likely to mislabel white defendants as lower risk than black defendants.57 The dangers of the failure to adequately regulate the use of AI to prevent discrimination have also been witnessed in Europe. The ‘Crime Anticipation System’ (‘CAS’), a predictive policing software being used across the Netherlands, was initially designed to consider ethnicity as a relevant factor for determining the likelihood of a crime being committed. Amongst the indicators used by CAS to predict crimes in a particular area was the number of ‘non-Western allochtones’ in the area – in other words, ‘non-Western’ individuals with at least one foreign-born parent.58 The software not only presupposed the existence of a correlation between ethnicity and crime, but also singled out a category of ethnicities to be of particular concern, given that the presence of ‘Western’, ‘autochtone’ individuals were not used as indicators. Furthermore, given that ‘Western’ was defined somewhat subjectively (for example, including individuals of Japanese or Indonesian origin, and including all European nationalities, apart from Turkish), CAS incorporated highly questionable societal categorisations and biases. In the United Kingdom, a major criticism of HART has been that it included data collated and classified by a private company for marketing purposes that could very easily to biased outcomes. HART relied on the ‘Mosaic’ code developed by a consumer credit reporting company, that categorised individuals into various groups according to inter alia their ethnic origin, income, and education levels. It was of particular concern that some socio-demographic categories used by Mosaic were blatantly racialised, including, for example, ‘Asian Heritage’, which stereotyped individuals of ‘Asian’ origin as being unemployed or having low-paid jobs, and living with extended families.59 In Denmark, an automated algorithmic assessment has been used to classify different neighbourhoods, based on criteria such as unemployment, crime rates, educational attainment, and other ‘risk indicators’, as well as whether the levels of first and second-generation migrants in the population is more than 50%. Neighbourhoods which meet these criteria are classified as ‘ghettos’. These neighbourhoods are then subject to special measures, including higher punishments for crimes.60 It is clearly discriminatory, as well as entirely unfair, for people living in certain areas to be punished more severely than others in different areas for the same crimes. Further examples of criminal justice AI which have been identified as producing discriminatory outcomes include the previously mentioned OASys, NDAS and the Gangs Matrix in the UK, and the Netherland’s ProKid 12. These examples illustrate the need for regulations to ensure that AI systems are designed to be non discriminatory, and to exclude categorisations and classifications that deepen and legitimise social biases and stereotypes. However, policy makers should not assume that making AI systems blind to all protected characteristics will always help to produce non-discriminatory outcomes. In certain scenarios, the removal of protected characteristics from the data could worsen discrimination. For example, it has been suggested on the basis of research into COMPAS in the United States, that excluding gender as a variable for risk assessments would fail to reflect a well-established statistical fact that in most countries, women are less likely to reoffend than men.61 Making COMPAS gender blind would unfairly and inaccurately assume women to be as equally likely to reoffend as men, and discriminate against them by overestimating their risk scores. Removing visible biases from AI systems cannot be the sole or primary solution to their discriminatory impact, because AI systems can be biased even if they have not been deliberately designed in that way. Bias is often unintentional, and even if the AI system appears on the surface to be neutral, their algorithms can lead to discriminatory assessments and outcomes. COMPAS, for example, does not include race or ethnicity as a variable, yet research has found that it consistently gives black defendants higher risk scores than their white counterparts, making them less likely to be released from detention.62 Hidden biases can arise in AI systems in numerous ways. Although a comprehensive analysis of how they can cause unintentional biases are beyond the scope of this paper,63 the way in which AI systems are themselves created and built illustrate the difficulty, complexity, and sometimes impossibility, in preventing discriminatory outputs and effects of AI systems. There are fundamental issues with the way AI systems are designed and created which can lead to bias. Where the AI system is based on machine-learning, biases can result from faults in the data that is used to train its algorithms. Machine learning systems ‘learn’ how to make assessments or decisions on the basis of their analysis of data to which they have previously been exposed. However, the data used to train a machine learning system might be incomplete, inaccurate, or selected for improper reasons, and this could lead to AI systems producing unwanted outcomes. What amounts to appropriate, good quality data for the purpose of training algorithms depends on what the machine learning system is being designed to do,64 so it might not always be obvious which dataset is needed to train algorithms to be non-discriminatory. AI designed or created for use in the criminal justice system will almost inevitably use data which is heavily reliant on, or entirely from within, the criminal justice system itself, such as policing or crime records. This data does not represent an accurate record of criminality, but is merely a record of policing – the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data might not be categorised or deliberately manipulated to yield discriminatory results, but it may reflect the structural biases and inequalities in the society which the data represents. Where there are discriminatory policing patterns targeting certain demographics, or the systematic under-reporting and systematic over-reporting of certain types of crime and in certain locations,65 the use of such data merely results in a reinforcing and re-entrenching of those inequalities and discriminationin criminal justice outcomes. For example, according to UK crime data, black people are over 9 times more likely to be stopped and searched than white people,66 and black men are more than 3 times more likely to be arrested than white men.67 Despite these statistics, NDAS (mentioned above) in the United Kingdom explicitly relies on stop and search data to determine an individual’s propensity to commit a criminal offence. The fact that stop and search is disproportionately used against black people means that there will inevitably be an overrepresentation of black people in NDAS and that their risk levels will be inflated in comparison to white people. Comparable statistics on stop and search are not available in most EU Member States, where the official collection of racially disaggregated criminal justice data is either forbidden by law, or not standard practice. However, recent studies show that racially biased policing practices are prevalent throughout the EU. Data collected from a survey by the Fundamental Rights Agency, for example, has shown that during a 5-year period, 66% of individuals of Sub-Saharan African origin in Austria, and over half of respondents of South Asian origin in Greece were stopped and searched.68 AI built on data embedded with such biases and used to assist, inform, or make decisions in the criminal justice system, can expand and entrench the biases represented in the data.69 When AI systems result in criminal justice outcomes which repeat the discrimination inherent in the historic data, such as targeting individuals from a particular demographic, that decision will itself be preserved in the data. This leads to self-perpetuating ‘feedback loops’ which reinforce patterns of inequality.70 Another way in which AI systems can produce unintentional biases is by way of proxies. Data used by AI systems might be classified in seemingly legitimate ways, but those classifications can sometimes act as proxies for protected characteristics. A common example used to illustrate this point is how home addresses or postcodes can be proxies for race or ethnicity.71 Certain AI systems, such as HART, were initially trained to find correlations between home addresses and the risk of reoffending – in other words, to identify which postcode areas have ‘higher-risk’ residents than others.72 This approach overlooks the fact that there is very pronounced ethnic residential segregation in many countries,73 making it highly probable in practice, for AI systems to inadvertently establish a link between ethnic origin and risk. Roma are especially vulnerable to this form of proxy discrimination, given that in many EU Member States, Roma are reported to live primarily in segregated areas inhabited mostly or exclusively by Roma.74 There are several ways in which AI systems can be designed to mitigate the risks of discrimination, including by identifying and excluding data classifications that act as proxies for protected characteristics.75 However, it can be difficult in practice to identify which variables are proxies for protected characteristics (and how they do so), and removing too many ‘offending’ variables might result in the AI system losing much of its functional utility.76 There is no one-size-fits-all method of ensuring that AI systems do not produce discriminatory outcomes. Different approaches to de-biasing AI systems can conflict with one another, and the suitability of a particular de-biasing method might depend on the AI tool itself, and the legal and policy context in which it is designed to operate.77 Biases in AI systems are often not easy to detect and, in many cases, it might also be difficult to pinpoint flaws either in the system itself, or in the training data that has been caused the bias. The structural bias within the data that AI systems are built and operated on, a bias which is particularly deep-rooted in criminal justice data, is a fundamental issue, and one which is likely to result in AI systems being fundamentally inoperable – both because the bias makes them morally and ethically inoperable, if not yet legally, and because any attempts to remove the bias will make the data to operate these systems unusable. Fair Trials’ view is that the only effective way in which AI systems can be regarded as non discriminatory is if they have been subject to rigorous independent testing for biases. These tests must be mandated by law, must be independently run, have clearly stated aims or objectives, and be carried out pre-deployment to reduce the likelihood of individuals being affected by discriminatory profiling and decisions. AI can be tested in advance of deployment by using test data – datasets which are either synthetic datasets,78 or by using historic data with permissions – running it through an AI system, and analysing the outputs.79 For example, a trial of retrospective facial recognition video analysis is being run by a police oversight Ethics Committee in the UK. The trial is using historic data – CCTV footage – as the basis for simulated investigations in a controlled environment, monitored by researchers. The trial has clearly stated aims and signifiers of success, and all outcomes will be examined. There are significant human rights, data protection and ethical concerns involved with this particular technology, including the right to privacy, and the testing is not being conducted independently as it should be but, as above, there are positive aspects of the testing methodology.80 An alternative could be to ‘test’ a system in a strictly academic sense by running it alongside actual criminal justice processes, but with the system not having any effect on decision-making, and analysing the system’s proposed decisions or outcomes for bias. AI should never be used or even ‘tested’ in real-world situations where they have actual effects on individuals or criminal justice outcomes, before they have been tested. These types of tests also need to be carried out in the broader context of an AI governance framework that not only analyses the potential impact of the AI system pre-deployment, but also continues to monitor its impact afterwards. If these tests are not carried out, and/or if an AI system cannot be proven to be non-discriminatory, it should be legally precluded from deployment. However, as explained in the final section of this paper, it is questionable whether such tests are feasible in many Member States, where local laws prohibit the collection of racially-disaggregated data. AI systems should be developed to generate non-discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race or ethnicity. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. If an AI system cannot be proven not to generate discriminatory outcomes, it should not be used. AI Systems need to be transparent and explainable AI systems can have a significant influence over criminal justice decisions, and they should be open to public scrutiny in the same way that all decision-making processes by public entities should be. However, a common criticism of many AI systems is that they lack transparency, which often makes it difficult, if not outright impossible, to subject them to meaningful impartial analysis and criticism. This lack of transparency is both as a result of deliberate efforts to conceal the inner workings of AI systems for legal or profit-driven reasons, and of the nature of the technology used to build AI systems that is uninterpretable for most, if not all humans. There are several reasons why it is necessary for AI systems to be transparent. Firstly, transparency is essential for strengthening confidence of both primary users of the system, as well as the general public, in AI systems. Democratic values demand that the public needs to be aware of how powerful public institutions, such as the police and the judiciary, operate so that they can be held accountable for their actions. It is also crucial for primary users of AI systems to understand how they work, so that they can make informed decisions about how much influence they should have on criminal justice decisions. Secondly, decisions made by AI systems need to be contestable at an individual level. Standards on the right to a fair trial and the right to liberty demand that defendants should have access to materials that inform decisions regarding them, so that they can challenge the accuracy and lawfulness of those decisions. Transparency also acts as a safeguard against bias and inaccuracies. It is difficult to imagine how issues that undermine the fairness and accuracies of AI systems (such as racial biases) can be detected, and ultimately fixed, if they cannot be properly accessed and analysed. As explained above, certain AI systems, such as CAS, have been found to have serious, but very obvious, flaws. In CAS’s case, however, the fault in the software could be detected easily, which meant that the discriminatory impact of the tool could be mitigated. The indicator for ‘non-Western allochtones’ in CAS was removed in 2017,81 ostensibly because it served no useful purpose, but presumably also because of the very obvious bias. This mitigation was possible because CAS is a transparent software, that was developed in-house by the Dutch police. The types of indicators used to predict crime were made openly available, and information about the method by which the software made predictions could easily be accessed and understood.82 This, however, is not the case for all AI systems, because AI systems are often developed by for-profit companies with little to no meaningful input from the public. As such, details of how they are designed, and how they make decisions and assessments are, in many cases, closely guarded as trade secrets that are protected by law.83 Often, AI systems are ‘black boxes’ because they are deliberately kept that way. While it is accepted that strong, enforceable intellectual property laws are needed to promote advancements in what is a very dynamic field of scientific research and innovation, it is not acceptable that these concerns trump the rights of individuals suspected or accused of crimes. In light of this, it is concerning that the Commission’s White Paper focuses on, and strongly promotes, the concept of a ‘partnership between the private and the public sector’ in relation to AI.84 Fair Trials appreciates that effective public-private collaboration could help to fill in gaps in public sector expertise and capacity for the development of AI systems, but given the transparency challenges, it is essential thatsuch partnerships are accompanied by robust regulations and rules that ensure effective and open scrutiny. However, even if AI systems are completely exposed to public scrutiny, and their source code85 and input data, for example, are openly disclosed, there is still no guarantee that they will be sufficiently transparent to enable adequate independent scrutiny. AI systems can be black boxes by nature of the technology that makes their decision-making processes complicated beyond comprehension for most (in some cases, too complicated even for computer scientists to understand).86 This is especially the case where AI systems are based on machine-learning algorithms. One possible reason for the unintelligibility of AI systems is that they sometimes use machine-learning algorithms that are simply too complex to be understood to a reasonable degree of precision.87 This is especially the case where AI systems incorporate ‘Deep Neural Networks’ – a machine-learning algorithmic architecture inspired by the structure and mechanics of human brains. Rather than relying on a set of man-made instructions, these types of AI systems make decisions based on experience and learning. Decision-making processes of this kind have been described to be ‘intuitive’, because they do not follow a defined logical method, making it impossible to analyse the exact process by which a particular decision is reached.88 It has also been suggested that some AI systems are uninterpretable to humans because the machine-learning algorithms that support them are able to identify and rely on geometric relationships that humans cannot visualise. Certain machine-learning algorithms are able to make decisions by analysing many variables at once, and by finding correlations and geometric patterns between them in ways that are beyond the capabilities of human brains.89 Given these challenges, there is widespread recognition that states should require AI systems to not only be ‘transparent’, but also explainable and intelligible.90 GDPR already recognises that individuals should have the right to an explanation of how a decision was reached, if they have been subject to an automated decision.91 In principle, this is an essential and very useful requirement, but it is also one that seems difficult to implement in practice, given that both ‘explainability’ and intelligibility are highly subjective concepts. Arguably, AI systems’ computing processes are inherently difficult to explain and understand for most people, including for most criminal justice decision-makers, but this surely should not be the sole basis for oversimplifying the technology, or for banning the use of AI outright. Computer scientists have been theorising different ways of ensuring that decisions made through complex algorithms can be explained and understood. An example is the ‘explainable AI’ movement (‘xAI’) that aims to build AI systems that can show more discernible links between inputted data and decisions. xAI systems measure how each input influences the final decision, so it is possible figure out how much weight is given to each input.92 This seems to be an innovative response to the ‘black box’ challenge, establishing clearer, more helpful relationships between inputs and final decisions. However, it appears to fall short of explaining what happens between data being inputted into the system and the final decision, and it does not enable users to impute any logic to the decision-making process.93 As explained above, there are various reasons why AI systems need to be transparent and intelligible, but the effective of exercise of the rights of the defence must be recognised as a crucial test for determining whether an AI system is sufficiently explainable and intelligible. AI systems have to be designed in a way that allows criminal defendants to understand and contest the decision made against them. Partnership for AI has suggested that a central factor that determines the contestability of AI systems is the possibility of carrying out an audit trail of the AI decision.94 In particular, it has to be possible for an auditor to follow and reproduce the process and come to the same conclusion reached by the AI system at the end. Furthermore, as explained in further detail below, criminal justice procedures should require the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings, and this disclosure should be in a form which is understandable to a layperson, without the need for technical or expert assistance. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, as well as the general public. Commercial or proprietary interests, or technical concerns, should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decision made against them. It should be possible to carry out an independent audit, and processes should be reproducible. Part 2: Safeguards for the use of AI Systems in Criminal Proceedings AI systems have to be built in accordance with human rights principles, and to give effect to human rights in practice, but it is unlikely that their design alone will guarantee that they are used in ways that comply with human rights. Regulatory frameworks for the design and deployment of AI systems have to be accompanied by appropriate legal safeguards that ensure they are used responsibly and lawfully. There are two primary questions that need to be addressed: 1) how procedural rules ensure that decision-makers do not over-rely on AI systems; and 2) how decisions and assessments made by AI systems can be analysed independently and challenged. Combatting ‘Automation Bias’ and Reinforcing Meaningful Human Input One of the main challenges of automated, or semi-automated decision-making systems is that of ‘automation bias’ – the tendency to over-rely on automation in ways that can cause errors in decision making. Automation bias occurs primarily due to the perception that automated decision-making processes are generally trustworthy and reliable. Automated cues have been found to be particularly salient to decision-makers, and research has shown that users of automated decision-making systems have a tendency to place greater weight on automated assessments over other sources of advice.95 The disproportionate influence of automated systems can undermine the quality of decision-making, by discouraging its users from consulting a wider range of factors that could inform more accurate decisions. Most AI systems currently being used to assist criminal justice decision-making do not completely replace human decision-making. They are instead designed and deployed to be used as decision aids, whose outputs are factored into consideration for the purposes of human decision-making. The phenomenon of automation bias however, raises questions about whether AI systems are being used in reality in accordance with their intended purpose as decision aids, and not as de facto replacements for human decision-making processes. There is strong evidentiary basis for automation bias amongst pilots who, like judges and other decision-makers in criminal justice proceedings, have typically been through a high level of training to make appropriate decisions in highly complex settings.96 However, limited research into automation bias amongst judges suggests that AI systems might have a more complex impact on judges’ behaviour. For example, a study conducted in 2019 in Kentucky seems to suggest that the degree to which judges rely on predictive tools for pre-trial detention decision-making could be influenced by the ethnicity of the defendant.97 The research indicates that judges had a greater tendency to rely on algorithmic risk assessments where the defendant was white, whereas in cases where the defendant was black, judges were more likely to overrule the risk-assessment in favour of detaining them. This study appears to show that AI systems can influence judges’ behaviour in unpredictable ways, especially where there are interactions or conflicts between automation and human biases, and that AI systems might be an ineffective tool for challenging human prejudices. It is crucial that rules governing the use of AI systems in criminal proceedings actively try to counter automation bias, and to encourage decision-makers to make independent determinations. A simple requirement to have a human decision-maker ‘in the loop’ or to have a human decision-maker review or check the automated decision is insufficient, because this risks overestimating the capacity or willingness of human decision-makers to question and overrule automated decisions. A mere requirement to have an automated decision reviewed by a human, on its own, could reduce the human review into a rubber-stamping exercise which, in practice, is no oversight at all. In recognition of this challenge, the European Data Protection Board has recommended that in order for decisions to be regarded as not ‘based solely’ on automated processing for the purposes of Article 22 GDPR, there has to be ‘meaningful’ human oversight, rather than just a token gesture.98 What qualifies as ‘meaningful’ intervention is open to interpretation, and it is likely to differ depending on the circumstances and the type of decision being made. In the context of criminal justice procedures, where decisions often have particularly severe and far-reaching implications for individuals’ rights, safeguards for ensuring meaningful human intervention have to be especially robust. Procedural safeguards that ensure ‘meaningful’ human oversight Rules governing the use of AI systems in criminal justice proceedings have to counter automation bias by encouraging human decision-makers to treat their processes with scepticism, and to force them to challenge and scrutinise the outcomes of algorithmic assessments. Procedural safeguards that can be put in place to tackle automation bias include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easier for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. One way of ensuring that automated assessments and decisions do not have undue influence on judicial decisions might be to ensure that decision-makers are sufficiently informed and alerted about the risks of relying on AI systems. This seems to be the approach taken by the Wisconsin Supreme Court in the United States in the case of Loomis,99 in which the Court considered whether or not the use of the COMPAS risk assessment tool for sentencing purposes violated due process rights. The judgment in Loomis recognises the importance of procedural safeguards as a way of safeguarding fairness of decisions, by requiring the use of ‘written advisements’ to alert decision-makers about the potential risks of AI risk assessments. Specifically, the court mandated that these advisements had to include warnings that: a) the process by which the COMPAS produces risk scores were not disclosed due to its ‘proprietary nature’; b) the accuracy of risk scores are undermined by the fact that COMPAS relied on group data; c) the risk-assessment tool had never been tested locally for accuracy; d) ‘questions’ have been raised about the discriminatory effect of COMPAS risk-assessments; and e) COMPAS was developed to inform post-sentencing decisions, but not sentencing decisions themselves. These warnings are clearly very specific to COMPAS and the context in which it is used in Wisconsin. If similar safeguards were adopted in different contexts and with regard to different AI systems, advisements will no doubt need to be adapted. The warnings used in Loomis have, however, been criticised because they do not give enough information to decision-makers to enable them to appreciate the degree to which these risk-assessments should be discounted.100 In particular, the advisements are silent on the strength of the criticisms against COMPAS, and they say nothing about the basis on which questions about their discriminatory effect have been raised.101 These warnings also give no indication about likely margin of error of the assessment, so although judges are informed that some assessments might be inaccurate, they are not in a position to appreciate how serious or frequent these errors might be. ‘Advisements’, or warnings that encourage decision-makers to be sceptical of AI systems cannot be considered as effective safeguards, unless they contain sufficiently helpful information for decision makers. However, even if judges are given stronger warnings than those in the Loomis advisements, it is still doubtful whether they alone will adequately mitigate automation bias. One reason for this is that many criminal justice decisions (such as pre-trial detention decisions) are, in practice, made very routinely by judges. Although written advisements might initially help judges think more critically about automated risk assessments, over time, these advisements could become repetitive and routine, and lose much of the intended meaning and effect.102 An effective safeguard that could work in conjunction with mandatory warnings could be for decision makers to be given a better insight into how AI systems produce a particular assessment or calculation. As mentioned above, the lack of information about how assessments are made by AI systems makes it harder for criminal defendants to scrutinise and challenge them. Surely, this has to be true also for decision-makers. It is much harder, if not impossible, to analyse and criticise decisions if there is no reasoning behind them. While AI systems do not rely on ‘reasoning’ per se, information given to decisions about how a specific assessment was made, including what factors were relevant, and how much weight was given to each factor could give decision-makers more confidence to decide whether to agree or disagree with an AI-generated decision. Decisions or assessments made by AI systems cannot be the sole basis of criminal justice decisions – they should be no more than a factor that can influence human-decision making. As such, decision makers should be required to show that decisions were influenced by a broader range of factors other than the AI system, by way of fully reasoned, case-specific, written decisions. Research has shown that the lack of case-specific reasoning in pre-trial detention decisions is already a serious challenge in many EU Member States,103 and AI systems risk worsening the standardisation of such decision making processes. Where AI systems are used to inform pre-trial detention decisions, or any other criminal justice decision that has a significant impact on the rights of the defendant, reasoned decisions must be specific to the defendant’s case, and in particular, they must reveal what which factors influenced the decision, and to what degree. In particular, decisions have to make it clear how much weight was given to assessments by AI systems. It is also crucial that decision-makers are able to override decisions made by AI systems, and that they are confident about doing so where the tool produces assessments or recommendations that are unfavourable to the defendant (e.g. where the AI system advises against releasing the defendant). It has been reported that members of the police force in Avon and Somerset Police in the United Kingdom are expected to record incidences where they have disagreed with assessments made by a predictive policing tool, and to explain their reasons for the disagreement.104 This is likely to act as a strong disincentive for overriding decisions made by the AI system, and as such, it actively facilitates automation bias. Furthermore, it seems to interfere with the presumption of innocence by making it difficult for decision-makers to override AI systems to make decisions that favour the defendant. If an AI system recommends the arrest or the detention of an individual, decision-makers should feel that they have a genuine choice of overruling the AI system, and not be pressured into compliance. Criminal justice decision-making processes should, as a general rule, be skewed in favour of the defence to give effect to the presumption of innocence, and rules governing the use of AI systems should favour favourable outcomes for defendants. On the other hand, in cases where a decision-maker acts against the advice of an AI system that recommends a favourable outcome for the defendant, there should be a requirement for reasons to be given for their decision. This is to prevent unfavourable outcomes for defendants that are motivated by improper reasons, and to mitigate the risk of unconscious bias. Challenging AI in criminal proceedings AI systems need to be contestable by criminal defendants. This is so that they can not only challenge the outcomes of the AI systems’ calculations and analyses, but also scrutinise the legality of their use. In other words, being able to challenge AI systems in criminal proceedings is not only a procedural fairness requirement for defendants, it is also a means by which legal standards governing AI systems and their use can be enforced. One of the major issues preventing the sufficient contestability of AI systems in criminal proceedings is the lack of notification. If an individual is not notified that they have been subject to an automated decision by an AI system, they will not have the ability to challenge that decision, or the information that the decision was based on. For example, in the United Kingdom, the Data Protection Act 2018 sets out the applicability of the GDPR and sets out the UK’s interpretations of the GDPR’s requirements and safeguards. However, section 14 of the Data Protection Act significantly dilutes the requirements of Article 22 of the GDPR, permitting purely automated decisions which have legal or similar significant effects on a data subject, without their consent, as long as the data subject is subsequently notified that a purely automated decision has been taken about them, after the decision has been made. It is only then that the data subject has the opportunity to request a new decision. However, it has been reported that individuals subject to decisions by the HART system in the UK are not notified at all that they have been subject to such an automated decision, even after it has been made.105 This is likely because under the Data Protection Act 2018, automated decisions which have legal or similar significant effects on a subject are not necessarily classified as ‘purely automated’ if a human has administrative input. In order to meet this requirement, the human input can be as minimal as checking a box to accept the automated-decision, even if it has a significant impact on an individual, such as holding them in custody. This minimal requirement for human requirement means that, in practice, decisions made with negligible to no meaningful human input can be classified as not “purely automated” and there is no legal requirement to notify and ability to request a new decision. In this way, systems such as HART continue to be used, with people subject to their decisions completely uninformed. While the GDPR already requires the notification of individuals affected by automated decisions, the UK’s experience with HART highlights the need for stricter rules to not only ensure meaningful human input (as mentioned above), but to also strengthen the individual’s right to be notified. There must be a requirement for individuals to be notified, not just for “purely automated” decisions, but whenever there has been an automated decision-making system involved, assistive or otherwise, that has or may have impacted a criminal justice decision. This notification should include clear and comprehensible information about the decision that has been taken, how that decision was reached, including details of the information or data involved in reaching that decision, what the result or outcomes of the decision are, and what effects, legal or otherwise they have, and information on how to challenge that decision. As discussed in the previous section, a further major barrier to the contestability of AI systems is a technical one. The ‘black box’ nature of certain AI systems can be largely attributed to their design, so it is important that there are rules governing the interpretability of these systems so that when they are in use, their processes can be understood at all. However, there are also legal barriers to the full disclosure of AI systems, which are often put in place to protect commercial interests. Procedural safeguards play a particularly important and effective role in addressing these types of opacity challenges. Transparency is a fundamental aspect of an adversarial process that underpins the right to a fair trial, and human rights standards require that as a general rule defendants should be given unrestricted access to their case-file,106 and to be given the opportunity to comment on the evidence used against them.107 These standards are further reinforced by Directive 2012/13/EU,108 which requires Member States to grant access to all material evidence in possession of the competent authorities to the defence to safeguard the fairness of the proceedings and to enable defendants to prepare their defence.109 The procedural requirement of an adversarial process is not one that is limited to substantive criminal proceedings – it also applies in the context of pre-trial decision-making processes, especially for decisions on the deprivation of liberty.110 While EU law and international human rights law also recognise that there might be certain justifications for non-disclosure of materials used against the defendant in criminal proceedings, these are narrow restrictions, and commercial interests are not regarded as a valid justification for non-disclosure.111 Furthermore, EU law does not explicitly recognise any derogations from the right of access to materials that are essential to challenging the lawfulness of an arrest or detention.112 In order for Member States to comply with these standards, any exceptions to the disclosure of information regarding AI systems have to be applied very narrowly. Barriers to scrutiny and accountability of AI systems are not only legal, but also technical. As explained in previous sections, many AI systems suffer from interpretability issues because of their design and by the nature of the machine-learning technology upon which they rely. In the absence of specific expertise on AI, it is difficult to imagine how, in practice, defendants and their lawyers will be able to challenge AI systems. One possible solution to this challenge, as explained below, is training for defence lawyers – but it is unreasonable to expect lawyers to develop expertise that would enable them to analyse and scrutinise AI systems at a technical level. A further solution could be that defence lawyers have access to the relevant expertise from suitably qualified professionals. However, in reality, not all criminal suspects and accused persons are able to access the legal and other technical assistance needed to understand and challenge technically complex AI systems, for financial or other practical reasons. It would also be unreasonable and unrealistic to require all suspects and accused persons to engage technical expertise just to be able to understand how an AI system makes a decision, especially where AI systems are used routinely or mandatorily to make or assist criminal justice decisions. It might seem unreasonable to expect all highly technical evidence to be challengeable by lay defendants without the help of a suitable expert. However, AI systems are not necessarily used in criminal proceedings as ‘evidence’, and in practice they could be an integral part of a decision-making process, or even a replacement for it. As such, it is essential that the ‘reasoning’ of AI systems are made known to suspects and accused persons, similarly to how judicial decisions must contain “sufficient reasoning and address specific features of a given case”, especially where they concern the deprivation of liberty.113 Decision-making processes of AI systems and the way in which it has produced an outcome in a particular case should thus be disclosed to suspects and accused persons, in a form that is intelligible to a layperson. Individuals should not need to rely on experts to simply understand how a decision affecting them was made. While there will inevitably be scenarios where defendants would need expertise to challenge an AI-assisted decision, but these cases should be the exception, rather than the norm, for whenever an AI system is used. Criminal justice procedures should require the notification to suspects and accused persons where an AI system has been used which has or may have impacted a decision made about that individual. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is comprehensible to a layperson, without the need for technical or expert assistance, and suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training AI systems use technology not well understood by many people. Without proper training, outputs of AI systems might not be easy to interpret, and it might be difficult to appreciate which factors undermine the reliability of AI systems, so that appropriate weight can be attached to their findings. As mentioned above, decision-makers can be warned about the weaknesses of AI systems as part of their decision-making process, but the effectiveness of this safeguard can be questioned, because it is unlikely to provide decision-makers with all the information they need, and there is no guarantee that the warnings will be taken seriously in all cases. Training is not just needed for the primary users of AI systems, such as judges and police officers who use them to inform their own decisions. The training must also be available criminal defence lawyers, so that they are in a better position to challenge AI systems, where necessary. If AI systems are used routinely to aid criminal justice decisions or even made mandatory (as is the case in certain states in the United States), there would be strong justification for governing bodies to make training on AI mandatory for criminal justice practitioners. Part 3: Governance and Monitoring Criminal justice processes are an important enforcement mechanism for ensuring that AI systems are designed and used lawfully, but they cannot be the sole, or even the primary means of implementing legal and ethical standards. Of equal, if not greater importance is a framework that ensures that policy decisions on the design and deployment of AI systems are made in systematised way, and that unlawful or harmful AI systems never enter into public service. Member States that deploy AI systems for criminal justice purposes should have regulatory mechanisms that are fit for purpose. At a minimum, these should include frameworks for: a) pre-deployment impact assessments; b) post deployment monitoring and evaluations; and c) collection of data needed for effective comparative analysis. Pre-Deployment Both the GDPR and LED recognise the need for AI systems to be analysed before they are deployed, so that they comply with existing regulatory and human rights standards. Under Article 35 GDPR, Member States are required to carry out a ‘Data Protection Impact Assessment’ (‘DPIA’) for data processing systems that carry out ‘a systematic and extensive evaluation of personal aspects relating to natural persons which is based on automated processing, including profiling and on which decision are based that produce legal effects concerning the natural person or similarly significantly affect the natural person’. The corresponding provision in the LED is Article 27, which similarly calls for DPIAs to be carried out where processing of data is likely to result in a ‘high risk to the rights and freedoms of natural persons’. DPIAs under both laws have to carry out inter alia an assessment of the possible impact of the data processing system on the rights or individuals, and they need to mention what measures will be in place to ensure that their rights are properly protected. DPIAs help to address a serious accountability challenge, but EU laws do not provide sufficiently helpful standards on how they should be conducted. Article 27 LED does not lay down minimum requirements for how DPIAs should be carried out. On the other hand, there are aspects of Article 35 GDPR which, if used to guide how DPIAs should be conducted for AI systems used in criminal justice, would raise concerns. The foremost challenge is the level of transparency mandated by the GDPR. DPIAs are envisaged largely as internal processes led by the data controller, who may seek the opinions of data subjects (such as members of the public or their representatives), where it is ‘appropriate’ to do so. The GDPR also explicitly recognises that the requirement to seek the views of data subject is ‘without prejudice to the protection of commercial interests’.114 As outlined above, transparency is a key aspect of a fair criminal justice system and, as a general rule, all criminal justice decision-making processes need to be open to public scrutiny. There is no reason why AI systems should be exempt from this requirement and, given that administration of criminal justice is a matter of strong public interest, the public should have the right to voice their opinions and raise objections whenever AI systems impact criminal justice processes. Also, given the highly technical nature of AI systems, and their (as yet) poorly understood impact on society, impact assessments must have multi-disciplinary expert engagement. 115 In particular, DPIAs should always involve independent experts (computer scientists, in particular) who can audit, analyse, and if possible, ‘explain’ AI systems, so that they can help legal, policy and social science experts to determine the likely implications for the individuals’ rights. For public and expert consultations to be meaningful and effective, sufficient information should be made available to interested parties so that the AI system can be thoroughly understood and researched. Partnership on AI has recommended that for criminal justice risk-assessment tools, training datasets,116 architectures and algorithms of AI systems should be made available to ensure meaningful scrutiny.117 Commercial interests should not be regarded as a legitimate ground for limiting the disclosure of this information. Secondly, Article 35 GDPR allows data controllers to carry out a single DPIA ‘for a set of similar processing operations that present similar high risks’. There is a danger that this provision could be interpreted too broadly if Member States are given free rein to determine what two systems can be regarded as sufficiently ‘similar’. There are risks in assuming that an AI system well-suited for use in a particular context or within a particular geographic area will be equally useful in another. AI systems built using data from one jurisdiction might not be able to reflect differences in, for example, law enforcement culture and patterns of behaviour, laws and policies, and socio-demographic characteristics of another jurisdiction.118 Sometimes, these differences can be seen in the same country or even within the same region. For example, a study of ‘PRECOBS’ a predictive policing tool used in Baden-Wurttemberg in Germany, found significant differences in predictive utility between rural and urban areas.119 Finally, DPIAs seem to require data controllers to theorise the possible impact of AI systems, but there is no strict requirement for AI systems to be subject to testing or auditing before, or immediately after deployment. This overlooks the fact that flaws in AI systems, including unintentional biases, are not always easily detectable, and that they might only surface once the system is put into operation. As discussed earlier, the causes of biases in AI systems can be difficult to identify, and it is difficult to appreciate how, short of thorough testing, the true impact of AI decisions can be known. In New York, the AI Now Institute has proposed an alternative model for impact assessments, known as ‘Algorithmic Impact Assessments’ (‘AIAs’).120 The AIA framework sets out in detail how public authorities should conduct impact assessments of AI systems, and it can be contrasted with the provisions of the GDPR in that AIAs place much greater emphasis on the need for community engagement and consultations with external experts. This framework could serve as a useful guide for Member States seeking to establish pre-deployment procedures for approving AI systems. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. AI systems must be tested for impact pre-deployment, and systems should be precluded from deployment until they have undergone this testing and achieved minimum standards, such as non-discrimination. Post-Deployment Impact assessments of AI systems should not be regarded as ‘one-off’ processes. They have to be followed up with ongoing post-deployment monitoring and evaluation, so that the longer-term impact of AI systems can be understood, and shortcomings and biases that affect the rights of individuals can be identified and fixed. The ability of AI systems to deliver fair and just outcomes, and to meet policy objectives can be difficult to predict from the outset. Although AI systems can be validated and tested prior to deployment to check if they are likely to produce desired outcomes, their impact in the real world might be different. Furthermore, even if the likely outputs of AI systems can be predicted, it is much harder to estimate the likely impact they will have on human decision-making.121 Further reviews of AI systems are also necessary because criminal justice systems and the societies in which they operate change over time. A study in the United States, for example, theorises that many pre-trial risk assessment tools might be making predictions based on historic data that is no longer fit for purpose. It has been suggested that because data used to train risk assessment algorithms pre date bail reforms in many US jurisdictions, the impact of recent measures introduced to reduce the risk of failure-to-appear, such as transportation assistance and text message alerts are not taken into consideration – potentially leading to over-incarceration.122 Socio-demographic changes might also require AI systems to be altered so that they continue to be fit for purpose. If, for example, an area experiences high levels of net migration which results in rapid changes to policing patterns and judicial behaviour, AI systems might need to be reviewed to make sure they are not unintentionally worsening racial discrimination. Data Collection It is difficult to imagine how the impact of AI systems can be assessed, if there is inadequate data to support effective monitoring. The deficiency of criminal justice data across the EU has been subject to criticism. In particular, Fair Trials has found that most EU Member States do not systemically collect statistics on the duration of pre-trial detention, outcomes of criminal cases of pre-trial detainees, and the likelihood of a suspect or accused person being released by the court.123 The data needed for effective monitoring and evaluation depends on the function of the AI system and its intended objectives, but the lack of criminal justice data more generally questions whether Member States currently have adequate legal and policy foundations for introducing AI systems responsibly into criminal justice processes. Data needed for monitoring and evaluation purposes will, of course, need to have been collected from well before the introduction of the AI system, so that a proper pre- and post- analysis comparison can be made. Of particular concern is that in most EU Member States, race or ethnic data on criminal justice is not available, either because there is no systemised process for collecting it, or because local laws ban this practice altogether.124 This is a serious challenge because the most predominant criticism against the use of AI systems in the United States and elsewhere is that it worsens racial and ethnic bias in criminal justice decisions. Even without official statistics, there is strong evidence in many EU Member States that certain ethnic minorities, and in particular, Roma and people of colour are unfairly overrepresented in criminal justice systems.125 It is worrying that AI systems might worsen this discrimination, but that there will be no way of detecting this trend, because of the lack of data. Furthermore, the absence of racial and ethnic data could also prevent pre-emptive measures to combat racial bias. It is doubtful that developers will be able to design systems free from racial bias, if they have no data against which to measure their performance. On data collection, Fair Trials believe that EU and its Member States will need to make a strict choice. Either they should ensure that racially disaggregated criminal justice data is collected, or AI systems should be banned where they make individualised assessments for criminal justice purposes. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity.
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Answer the following question using only details found in the attached paper. You should NOT reference outside sources or your own knowledge.
EVIDENCE:
Executive Summary ‘Artificial Intelligence’ (‘AI’), comprising machine-learning and other analytical algorithm-based automated systems, has become an important aspect of our lives. In recent years, this technology has been increasingly deployed in criminal justice systems across the world, playing an increasingly significant role in the administration of justice in criminal cases. This trend is often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost savings in policing and court services. However, studies in various jurisdictions, including in Europe, provide substantial evidence that AI and machine-learning systems can have a significantly negative influence on criminal justice. AI systems have been shown to directly generate and reinforce discriminatory and unjust outcomes; infringing fundamental rights, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design that does not comply with human rights standards. Most AI systems used in criminal justice systems are statistical models, based on data which is representative of structural biases and inequalities in the societies which the data represents, and which is always comprehensively lacking in the kind of detail that is needed to make truly ‘accurate’ predictions or decisions. The data used to build and populate these systems is mostly or entirely from within criminal justice systems, such as law enforcement or crime records. This data does not represent an accurate record of criminality, but merely a record of law enforcement - the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data reflects social inequalities and discriminatory policing patterns, and its use in these AI systems merely results in a reinforcement and re-entrenchment of those inequalities and discrimination in criminal justice outcomes. Given these extremely serious risks, strong regulatory frameworks are needed to govern the use of AI in criminal justice decision-making and, in some circumstances, to restrict its use entirely. Existing EU data protection laws restrict the use of automated decisions, but there are gaps and ambiguities that could result in the use of AI systems in ways that undermine human rights, if not accompanied by further guidance or legislation. Firstly, EU laws currently only prohibit decisions that are solely based on automated processes, but they do not regulate decision-making processes that are largely dependent on automated systems. Given that most AI systems in use today are designed and deployed to assist, rather than replace, human decision-making in criminal justice systems, they largely fall outside the remit of EU data protection laws on automated decisions. Secondly, the prohibition on automated decisions is subject to broad exceptions. Individuals can be subject to decisions based solely on automated processes if authorised by EU or Member State law, and there are deemed to be appropriate human rights safeguards in place, including the right to obtain human intervention. However, there is not enough clarity on what safeguards are needed, and how ‘human intervention’ should be interpreted. In order to regulate the use of AI in criminal justice proceedings, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. The design of AI systems and their deployment in criminal justice proceedings should be regulated to generate human rights compliant, non-discriminatory outcomes. Minimum standards and safeguards should be set, which, if they cannot be adhered to, should preclude the use of the AI system in question. AI should also be regulated so that they are sufficiently transparent and explainable to enable effective independent scrutiny. AI systems should be designed and deployed to comply with and give effect to inter alia the right of access to court, the right to be presumed innocent, and the right to liberty. AI systems should not undermine the right to be tried by an impartial and independent tribunal and, in line with existing EU laws, no individual should be subject to an automated decision that results in a criminal record. AI systems should be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure that they have the desired effect of reducing pre-trial detention rates. AI systems must be developed to guarantee that they do not generate discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race, ethnicity, nationality or socioeconomic background. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. AI systems which cannot adhere to this minimum standard should have no place in the criminal justice system. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, and the general public. Commercial or proprietary interests should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decisions made against them. It should be possible to carry out an independent audit of each AI system, and its processes should be reproducible for that purpose. Member States should have laws that govern how AI systems are relied upon in criminal proceedings, and there must be adequate safeguards to prevent over-reliance on AI by decision-makers, to prevent discrimination and to ensure scrutiny and effective challenge by the defence. Procedural safeguards should actively tackle automation-bias amongst criminal justice decision makers. Examples include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easy for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. Criminal justice procedures should ensure that defendants are notified if an AI system has been used which has or may have influenced a decision taken about them at any point in the criminal justice system, from investigation to arrest, from charge to conviction, and sentence. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is clear and comprehensible to a layperson, without the need for technical or expert assistance, in order to ensure fairness, equality of arms, and to discharge the obligations to provide all relevant information and be given reasons for decisions under the right to a fair trial. Suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training should be made available to all primary users of AI systems, and to criminal defence practitioners, so that there is greater awareness of AI technology, and of the risks of over-reliance on AI. Effective regulation of AI systems should be facilitated by a governance and monitoring framework. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. A requirement of the assessment should be a consideration of whether it is necessary to use AI in the particular use case, or whether an alternative solution could achieve the same aims. As far as it is possible to do so, AI systems should also be tested for impact pre-deployment, a part of which should be the minimum requirement to prove that the AI system has no discriminatory impact, either directly or indirectly, before it can be deployed. AI systems should be kept under regular review post-deployment. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity. Background Rapid technological advancements in recent years have made artificial intelligence (‘AI’) an increasingly prominent aspect of our lives. There are differences of opinion as to the definition of AI and its true meaning, but for the purposes of this paper we are broadly referring to automated decision-making systems based on algorithms, including machine-learning, which are used in the criminal justice system. There is little doubt that AI has great capacity to increase human potential and improve the lives of many, but the increasing role of AI in assisting important public functions has also highlighted serious risks and challenges. If not subject to proper regulation and oversight, AI can threaten fundamental human rights and, far from expanding human potential, it can amplify and worsen harmful aspects of our society, including inequality and injustice. This challenge is particularly evident where AI has been used to assist the administration of justice in criminal cases. In recent years, more and more jurisdictions across the world have begun to use AI technology to inform and assist policing and judicial decisions, often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost-savings in policing and court services. In some countries, algorithmic processes can influence which geographic neighbourhoods should be subject to increased law enforcement and when, as well as which individuals should be specifically targeted by law enforcement. They can help to determine whether someone should be arrested, whether they should be charged with a criminal offence, whether they should be detained in prison before trial and, if convicted and sentenced, the length of their sentence. AI is being used more and more to influence highly sensitive, high impact decisions that have far reaching, long-term implications for individuals’ rights. Research emerging from the United States, where the use of AI in criminal justice is particularly widespread, and from the United Kingdom and some EU Member States, however, seriously questions whether AI has a positive influence on criminal justice systems. AI tools and systems have been found to actively generate discriminatory criminal justice outcomes, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design, that does not reflect or give effect to human rights standards. These criticisms might not be justified for all AI systems, but these studies highlight the need for much stronger regulatory frameworks to govern the use of AI. We believe that unless it is subject to robust regulation, it is unlikely that AI can be used in criminal justice systems without undermining the right to a fair trial. In some cases, it should be restricted from use entirely. EU Member States should be encouraged to take a much more cautious approach to AI and subject automated processes to more stringent rules that are designed to ensure human rights compliance. There is the potential for AI systems, if properly and robustly regulated, to have a positive impact on criminal justice system, advancing human rights, for example, by analysing law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination. The EU is already a world leader on AI regulation, having adopted ground-breaking data protection laws in recent years to shield individuals from automated decisions that have an adverse effect on their rights. We welcome the EU’s commitment to build further on existing legal standards, and we emphasise that addressing the impact of AI on criminal justice has to be a primary consideration for EU policy makers when deciding on appropriate legal standards. Discussions around the impact of AI on human rights have largely been centred on data protection, the right to privacy, and broader questions of ethics and human dignity. However, despite the increasing use of AI systems in criminal justice systems across the world, only limited discussions have so far focused on how these systems impact the right to a fair trial, and what regulations are needed to address that impact. About this paper Fair Trials has produced this policy paper to highlight the need for EU-wide standards on the regulation of AI in criminal justice, and to inform EU policy makers about the standards and safeguards needed to ensure effective protection of fair trial rights where criminal justice decisions are assisted by AI. The EU Commission recognised that AI represents risks for fundamental rights, including the right to a fair trial, in its 2020 White Paper, ‘On Artificial Intelligence – A European approach to excellence and trust’. It also recognised the need for improvements to the EU’s legislative framework on AI, noting in particular the challenges in the ‘effective application and enforcement of existing EU and national legislation’ and the ‘limitations of scope of existing EU legislation’. In this paper, we identify the most common fair trial rights issues raised by existing AI systems, based on examples and experiences from the EU, the United Kingdom, and the United States. We also offer examples of practical legal and policy solutions that could help to address these challenges, and to assist in the effective implementation of the EU’s fundamental rights standards in this area. We recognise that the use of AI has a broader impact on human rights beyond the right to a fair trial, and that there are important social and ethical issues that also need to be addressed. However, we have narrowed the focus of this paper given Fair Trials’ mission and field of expertise. This paper should not be treated as an exhaustive list of fair trial rights standards that need to be introduced. AI is used in many ways in criminal justice systems cross the world and, as the technology continues to develop, it is likely that we will eventually see the deployment of AI technology in ways never imagined before. This paper focuses primarily on AI systems that carry out individualised risk assessments, given that these types of systems have had the most significant impact on individuals’ rights so far, and we envisage that similar systems will become increasingly common in the near future. Existing EU Legal Framework Existing EU laws restrict the use of automated decisions in a wide variety of contexts. Article 22 of the General Data Protection Regulation (‘GDPR’) provides that data subjects have the right not to be subject to decisions ‘solely’ based on automated processes, where they produce ‘legal effects’ concerning them, or where they ‘similarly significantly affect’ them. The Law Enforcement Directive (‘LED’) – the EU data legislation that governs the processing of data for criminal justice purposes – has a very similar provision at Article 11, which requires Member States to prohibit decisions based solely on automated processing, where they produce ‘adverse legal effects’ on the individual, or effects that are ‘similarly significant’. However, there are two notable gaps in the existing legislative framework governing automated decision-making systems under both the GDPR and the LED. These ambiguities and potential loopholes could be exploited in ways that seriously undermine the general prohibition of automated decision-making processes, and adversely impact human rights. It is necessary, therefore, that the EU provides further guidance on how these provisions should be interpreted, including thorough legislation (if appropriate) to further clarify the circumstances in which Member States are allowed to deploy AI systems for criminal justice proceedings. Firstly, the provisions in the GDPR and LED only prohibit decisions based ‘solely’ on automated processes. In other words, the laws regulate the impact of decisions made through automated processing, but not the AI systems themselves. As discussed later in this paper, the main human rights challenges of AI systems can be attributed to how they are designed and trained, and the types of technology used, such as machine-learning, so it is crucial that decisions about the design and deployment of AI systems are also regulated. Secondly, neither the GDPR or LED provide regulatory standards to govern situations where automated processing is not the ‘sole’ basis of a decision, but a primary influencer. In reality, the difference between a fully automated decision and a decision made with a ‘human-in-the-loop’ is not always clear, but because of this strict classification, AI systems are able to be used and have significant legal effects without the corresponding safeguards. Stronger legal standards are needed to make sure that semi-automated decision-making processes do not become de facto automated processes. Thirdly, the prohibition on automated decision-making is subject to two very broad exceptions. Automated decisions are prohibited under the GDPR and LED, ‘unless authorised by Union or Member State law’ and there need to be ‘appropriate safeguards for the rights and freedoms of the data subject, at least the right to obtain human intervention’.1 These provisions give extremely wide discretion to Member States to override the general prohibition. It is significant that EU laws emphasise the need for human rights safeguards, and the need to ensure the possibility of human interventions, but neither of these concepts have yet been adequately defined. Although influential actors like the EU and the Council of Europe have established principles on the ethical and responsible use of AI, there is currently no authoritative guidance on the practical safeguards that need to be in place.2Likewise, the meaning of ‘human intervention’ is open to interpretation. LED provides some guidance on who should be carrying out the human intervention,3 but there needs to be greater clarity on what meaningful human intervention entails in different contexts. In order to regulate the use of AI in criminal justice proceedings, and close the gaps in existing data protection laws, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. Part 1: Regulating the Design and Deployment of AI Systems in Criminal Justice Systems AI systems deployed to assist criminal justice decision-making have to be fit-for-purpose. The purposes of AI systems differ depending on the context in which they are deployed, but there are a few common considerations that need to be taken into account to determine whether it is appropriate for the AI system to be used. Firstly, AI systems have to be designed to produce outcomes that are desirable from a human rights and non-discrimination perspective. This means that rather than being exclusively focused on delivering ‘accurate’ outcomes in criminal cases, AI systems have to be designed to facilitate fair, impartial and non-discriminatory criminal processes. Developers of AI systems and public entities that commission them should, in particular, make sure that AI systems are consciously designed to give effect to, and promote the right to fair trial. The fundamental issues with the way AI systems are designed and built, resulting in discriminatory outcomes, must also be considered. Given the significant evidence of AI systems influencing discriminatory outcomes, special efforts must be made to ensure that AI systems do not produce discriminatory outcomes. Secondly, AI systems need to be designed in a way that makes it possible for criminal defendants and the broader public to scrutinise them. This means that AI systems should not only be made open to scrutiny (rather than concealed to protect commercial interests), but their inner workings and processes should also be discernible and comprehensible. AI Systems should be designed to protect and promote the right to a fair trial Where AI systems are used to assist or inform criminal justice decisions, they support an important act of public administration that has a significant impact on the rights of suspects and accused persons. AI systems do more than just provide outputs that decision-makers can take into consideration as evidence. By attempting to mimic human analytical processes and reasoning, they can provide influential advisory input into human decision-making, or even replace it altogether. As such, it is right that human rights standards that govern criminal justice decision-making also apply to AI systems. The Council of Europe and the EU Commission’s High Level Expert Group on Artificial Intelligence (‘AI HLEG’) have both recognised that fundamental rights should be a key guiding principle for the design and deployment of AI systems.4 The Council of Europe recommends that AI systems are built according to ‘human rights by design’ principles, and recognises that AI systems should not undermine the right to a fair trial under the European Convention on Human Rights (‘ECHR’). The AI HLEG has similarly recognised that the respect for fundamental rights, as enshrined in the EU Charter of Fundamental Rights and international human rights instruments, should form the foundations of trustworthy AI. AI HLEG’s Ethics Guidelines for Trustworthy AI (‘the Ethics Guidelines’) also recognise the need for AI systems to comply with other types of EU legislation. Although not mentioned explicitly in the Ethics Guidelines, Fair Trials would emphasise that the design of AI systems and the ways in which they are deployed in the EU should, in particular, be compatible with the standards set out in the procedural rights directives under the ‘Roadmap for strengthening procedural rights of suspected or accused persons in criminal proceedings’.5 We would also like to note the potential for AI systems to have a positive impact on criminal justice systems. Public debate about the relationship between AI and human rights have predominantly been centred on the idea that AI is a threat to human rights. It is equally important, as technology takes an increasingly prominent role in public life, to consider what positive potential they may have. Policy makers, developers, civil society activists, and other stakeholders should try to identify ways in which AI can also play an active role in advancing human rights, and improve the fairness of criminal justice systems. For example, AI systems could be used to analyse law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination, for preventative purposes. AI systems which are used as part of criminal justice decision-making should be designed not just to ensure that they do not undermine the right to a fair trial, but also to promote it. However, as explained below, given the embedded biases in the criminal data used to develop and train AI systems, there are serious doubts, based on recent studies, whether AI systems can promote fair criminal justice at all. There are various aspects of the right to a fair trial and, without speculating on what kind of AI systems will be developed in the future to support criminal justice decision-making, it is difficult to articulate how fair trial rights standards should inform the design of AI systems. However, examples of AI systems currently deployed in the EU and elsewhere suggest that there are certain aspects of the right to a fair trial that require special attention. These are: a) the right of access to court b) the presumption of innocence; c) the principle of the equality of arms; and d) the right to liberty. Access to Court The notion of AI systems replacing courts to determine the guilt or innocence of the accused may seem far-fetched at present, but there is a growing trend of automated administration of justice across the world that might threaten the right of access to court. For example, in several European countries, speeding and other minor traffic offences have been detected and enforced by means of automated processes for more than a decade.6 Although nominally criminal processes, these types of proceedings are, in reality, normally administrative in nature, and they rarely have a ‘significant’ impact on the rights of individuals. However, as surveillance technology develops, thanks to AI, there is a real likelihood that the scope of crimes punishable by way of automation will increase.7 In the United Kingdom, the government announced plans in 2017 that would enable defendants to enter guilty pleas via an online portal after viewing the charges and evidence against them, for a small number of minor offences.8 Under this procedure, known as ‘automatic online conviction’, defendants would be automatically convicted and fined without any judicial oversight if they accept the charges against them. Although it is debatable whether this system can truly be characterised as an AI system, it is an example of the automated administration of criminal justice, that replaces a function usually played by courts. It is worrying that the UK government has proposed expanding this scheme to other ‘non imprisonable’ offences, if itis regarded as a success.9Fair Trials has outlined concerns about expanding the scope of cases where accused persons can be convicted without judicial oversight, even if such procedures are reserved solely for minor, non-imprisonable offences.10 The impacts of a criminal conviction, even for a minor offence, can be numerous, long-term, and hard to predict, affecting inter alia job prospects, educational opportunities, and immigration status. It is crucial that what amounts to ‘legal effects’ and ‘similar significant effects’ concerning the data subject for the purposes of automated decision-making are interpreted very broadly.11 In particular, given that a criminal record always has a ‘legal’ or ‘significant’ effect, any automated decision-making process that directly results in a criminal record should be prohibited. AI systems should not undermine the right to be tried by an impartial and independent tribunal, and in line with existing EU laws, no individual should be subject to an automated decision that resultsin their being held in custody or detention, gives them a criminal record, or which determines a criminal sentence or sanction. No individual should be subject to an automated decision which engages their human rights without meaningful human input. Presumption of Innocence The right to be presumed innocent in criminal proceedings is a basic human right, and one that is expressly recognised in, and safeguarded by EU law under Directive 2016/343 (the ‘Presumption of Innocence Directive’).12 The increasing use of AI in the sphere of criminal justice, however, raises questions about the scope of this right, and how AI systems should be built and used to protect it. Concerns about how AI systems undermine the presumption of innocence have been voiced in the context of certain types of predictive policing software.13 A variety of predictive policing tools that aim to facilitate preventative policing measures and to deter crimes before they have taken place have been developed and deployed across Europe.14 Tools which predict the time and place where certain crimes are likely to take place have been used in many European countries. Similar tools have also been developed to identify potential suspects, which are used widely in the US, and now increasingly in Europe.15 An example is the ‘Strategic Subject List’ in Chicago, a police database of around 400,000 local residents who were assigned threat scores that determine the likelihood that they will commit crimes.16 The algorithms used to generate these scores were not open to the public, so the exact process by which individual risk levels were assessed were not known. Despite this lack of transparency, it is clear that threat scores generated by the software had significant impacts on individuals’ rights – in particular, their right to privacy. Individuals with higher threat scores were, for example, more likely to be subject to targeted police surveillance, or home visits – as though they were officially recognised as predisposed to commit crimes, irrespective of any credible suspicion of wrongdoing.17 The Strategic Subject List was decommissioned in January 2020 by the Chicago police who cited ineffectiveness as the primary reason for the decision.18 These types of predictive policing tools are now being used in Europe. In the United Kingdom, a coalition of police forces have been developing a system not dissimilar to the Strategic Subject List, that aims to identify individuals who are likely to commit crimes.19 Known as the National Data Analytics Solution (‘NDAS’), this risk assessment tool uses statistical analysis and machine-learning to inform policing decisions, and to facilitate ‘early interventions’ where appropriate.20 The sources of data that the system uses to conduct its risk assessments raise concerns that the system will be built to profile individuals on the basis of very sensitive, personal information, including stop and search data, data from social services, and the National Health Service.21 Where this data is used to indicate the likelihood of individuals’ criminality, it will inevitably flag up people whose profiles fit those who are over-represented in that data as being higher risk. It is particularly worrying that an individual might be profiled for policing purposes on the basis of their health conditions or their access to essential services, such as welfare or benefits. These factors should not be regarded as relevant factors for determining whether someone may commit criminal offences. Also in the UK, the Metropolitan Police in London operates a database called the Gangs Matrix, which contains information and risk-assessments on individuals who are alleged ‘gang’ members.22 This database was created using criminal justice data, including police and crime records. The Gangs Matrix and the assessments it produces assists policing decisions, including the deployment of stop and search, and further enforcement action, such as imprisonment and deportation. A further tactic resulting from the risk assessments made by the Gangs Matrix is the threat of eviction or exclusion from education, as names and details of these alleged gang members have been shared with education, healthcare and housing providers.23 In the Netherlands, the government has been running an algorithmic risk assessment tool, ProKid 12- SI, which purports to assess the risk of criminality of 12-year-old children since 2009.24 ProKid uses existing police data on these children, such as reports of where children have come into contact with the police, their addresses, information about their ‘living environment’, even including whether they are victims of violence, to identify them as being in one of four categories of ‘risk’ of committing crimes in future.25 The system assesses children based on their relationships with other people and their supposed risk levels, meaning that individuals can be deemed higher risk by being linked to another individual with a high risk assessment, such as a sibling or a friend.26 Parents’ assessed risk can also impact a child’s risk level. ProKid’s algorithms assess risks in relation to future actions that the children have not yet carried out, and judges them on the basis of the actions of others close to them.27 These risk assessments result in police ‘registering’ these children on their systems and monitoring them, and then referring them to youth ‘care’ services.28 ProKid frames children as potential perpetrators even when they are registered as victims of violence; which has serious implications on their presumption of innocence.29 Several similar tools are also used in the Netherlands, including the Reference Index for High Risk Youth, a large-scale risk assessment system that focuses on assessing under-23-year-olds.30 Predictive policing tools like NDAS, ProKid and the Gangs Matrix can be regarded as part of a broader trend in law enforcement that moves away from ‘reactive’ policing, and towards ‘preventative’ or ‘proactive’ policing.31 NDAS and other similar predictive policing tools intend to pursue legitimate objectives of preventing, or reducing harm,32 but there are serious concerns that these systems single out individuals as ‘pre-criminals’, who are subject to police interventions even though they are not formally suspected of any crime, and there is no evidence that they have done anything wrong.33 It is of further concern that these types of predictive policing tools do not necessarily designate individuals’ risk levels on the basis of their past actions, or behaviour that can be regarded as ‘suspicious’ in any way, but on account of factors far beyond their control, and immutable characteristics. In particular, there is strong evidence to suggest that AI systems have a tendency to overestimate the risks of criminality of certain ethnic and racial groups. For example, out of 3,800 people on the Gangs Matrix, 80% are 12-24 years old, and 78% of them are black – a clearly disproportionate and discriminatory proportion. The discriminatory impact of AI in criminal justice systems is discussed in further detail in the following section. Although predictive policing tools do not directly ‘convict’ people, they not only allow the police to treat legally innocent individuals as pseudo-criminals, but they can also result individuals being deprived of their basic rights with regard to education, housing, and other public services – effectively ‘punishing’ them on account of their profiles. This seriously damages the fundamental human rights principle that the matter of guilt or innocence can only be determined by means of a fair and lawful criminal justice process.34 While it is clear that certain types of predictive policing can infringe the presumption of innocence from a moral and ethical viewpoint, it is debatable whether these systems also violate the legal presumption of innocence under EU law and international human rights law. The Presumption of Innocence Directive applies to natural persons who are ‘suspects’ and ‘accused persons’, from the moment they are suspected or accused of a crime.35 However, there is some ambiguity about the exact stage at which an individual attains the status of a ‘suspect’ under the Presumption of Innocence Directive,36 and about whether the scope of the Presumption of Innocence Directive extends to decisions to designate an individual as a suspect (or a ‘pre-criminal’). On the other hand, the ECHR appears to have taken a clearer position that measures undertaken pre-charge, as a general rule, fall outside the scope of the presumption of innocence.37 It has also held that preventative measures, such as surveillance, do not amount to criminal sanctions for the purposes of Article 6 ECHR.38 Even if the current language on the presumption of innocence is such that it is not directly applicable to the predictive policing context, it must be recognised that these tools nevertheless interfere with human rights. In particular, the targeted surveillance that results from predictive policing has clear implications on the right to privacy. The acceptable degree to which criminal justice processes can interfere with this right is a matter that might require clearer articulation, as is the question of the impact of Article 8 ECHR violations on criminal proceedings. AI systems that inform charging decisions have also been developed and deployed. An example of this is the Harm Assessment Risk Tool (‘HART’) currently being used by Durham Constabulary in the United Kingdom. HART uses a machine-learning algorithm to assess a suspect’s risk of reoffending, using over thirty variables that characterise an individual’s criminal history and socio-demographic background. The risk assessments conducted by HART are used by the local police to determine whether an individual should be charged, or diverted into a rehabilitation programme. HART does not determine whether an individual is guilty or innocent, but its assessment can trigger a chain of events that can result in the deprivation of liberty, and/or a criminal conviction. Charging decisions should surely be based on the merits of individual cases, and it is difficult to imagine how decisions on entry into diversion programmes can be made by means other than a careful consideration of individual circumstances. These types of high impact, fact-sensitive decisions should never be delegated to automated processes, particularly those which operate by identifying correlations rather than causal links between an individual’s characteristics and their likely behaviour. An examination of HART also reveals flaws in how the tool is designed. HART is calibrated to err on the side of caution,39 because it regards under-estimations of risk levels as a more serious error than over-estimations, so that under-estimations occur less frequently. In other words, HART is deliberately designed to underestimate who is eligible for entry into the diversion programme, so it is predisposed to over-criminalise. This approach conflicts with the notion that any doubt in a criminal case should be interpreted in favour of the defendant (‘in dubio reo’).40 A human rights compliant approach to criminal justice decision-making would do the opposite of what HART does – it would need to err on the side of the defendant. AI systems should respect the presumption of innocence and they must be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow or assist the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Equality of Arms A major concern raised in the studies of certain AI systems is that they are inaccessible for adequate scrutiny by defendants and their lawyers. This has serious implications for the principle of equality of arms and the right to an adversarial process, because without information about how a decision is made, it is difficult to envisage how defendants can question the accuracy and legality of the decision. The need for AI systems used in criminal justice to be transparent, explainable and understandable to all is addressed in more detail below. The Right to Liberty In the United States, ‘risk-assessment’ tools that use AI technology have been used to assist pre-trial assessments that determine whether a defendant should be released on bail, or held on remand pending their trial. Examples of risk-assessment tools currently being used in the United States include COMPAS, the Public Safety Assessment (‘PSA’), and the Federal Pre-Trial Risk Assessment Instrument (‘PTRA’). Many of these tools are also used to inform decisions on parole and sentencing. These tools have, however, been subject to intense criticism for several reasons. Studies have shown inter alia that risk assessments make inaccurate predictions that are no better than those made by non-expert humans. They do not result in a significant reduction in pre-trial detention rates, and that they produce disparate outcomes for different racial groups. The US-based NGO Partnership on AI has found that AI risk assessment tools currently being used in the United States are unfit for use in pre trial assessments, and it has recommended that policymakers cease the deployment of risk assessment tools until such time that the challenges affecting such tools have been adequately addressed.41 The adoption of pre-trial risk-assessments tools in the United States has largely been driven by the desire to address high imprisonment rates in the country by making pre-trial decision-making fairer. In particular, these tools have been promoted as an alternative to cash bail – a system often criticised for disadvantaging poorer defendants and worsening social injustices.42 Cash bail is a relatively rare concept in the EU, but there are concerns about the quality of pre-trial detention decisions in many Member States, which have been criticised for failing to carry out case-specific reviews and fully consider alternatives to detention.43 We are currently unaware of any attempts in EU Member States to introduce algorithmic risk assessments to supplement or replace existing pre-trial decision-making processes. However, it is possible that risk-assessment tools will also be recommended as a solution to address the pre-trial detention challenge in Europe, especially given that many of these tools are developed by private companies that actively market their products to governments and local police forces. Risk-assessment tools are usually designed to assess the likelihood of re-arrest, and/or of failure to turn up to court after being released based on the profiles of the defendant. Based on these assessments, risk assessment tools either assign risk levels to defendants, or they provide direct advice to decision-makers on whether or not the defendant should be released. There is only limited research about the extent to which pre-trial risk-assessment tools influence judges’ decisions in practice,44 but concerns have been raised about the ability of AI systems to recommend detention at all.45 There is a risk that recommendations made by AI systems to detain individuals compromise the presumption of release. This is a particularly valid concern in light of research suggesting that decision-makers have a tendency to err on the side of caution when they are ‘advised’ by AI systems, and that they have a greater propensity to override risk assessment tools to detain, rather than release defendants.46 Pre trial detention should always be a measure of last resort, and no risk-assessment can be regarded as human rights compliant, unless it recommends its users to consider detention as a measure of last resort, after all other alternatives have been fully considered. Pre-trial risk assessment tools in the United States and elsewhere have also been criticised for (unintentionally) over-estimating risks, because of the nature of the data used to train its algorithms. Pre-trialrisk assessment tools typically rely only on data regarding individuals who have been released, and they ignore those who were detained, but would have otherwise ‘succeeded’ by not being arrested, and by appearing in court.47 In other words, algorithms are based on the assumption that individuals who have been detained by courts in the past have been rightfully deprived of their liberty. Any AI system developed to assist pre-trial detention decision-making must be designed to give effect to the presumption in favour of release. This means that risk-assessment tools need to be deliberately calibrated to generate outcomes that favourable to the defendant. Data used to train the AI system should be carefully scrutinised so that it reflects the inevitable fact that a significant proportion of individuals in pre-trial detention have been deprived of their liberty in violation of their human rights. Studies of pre-trial risk-assessment tools used in the United States cast doubt on their effectiveness at reducing pre-trial detention rates, and their ability to make accurate predictions of risks. A study in Kentucky, for example, found that the likelihood of defendants being released within the first three days of their arrest went down after the risk-assessment tool was deployed, and that there were no significant changes in the number of re-arrests and failure-to-appear rates amongst defendants released on bail during the same period.48 This was the case even after the risk-assessment tool was modified post-deployment to improve the accuracy of predictions. Another study has found that the COMPAS risk-assessment tool is no better at predicting the likelihood of defendants reoffending than non-expert human volunteers.49 These studies do not necessarily prove that AI systems are incapable of reducing pre-trial detention rates at all, but they do raise questions about their usefulness, and they strongly challenge claims that algorithmic risk-assessment tools help to improve the quality of pre trial detention decisions. They also highlight the need for post-deployment testing and monitoring of AI systems, to ensure that they have the desired effect of ensuring that individuals are detained only as a measure of last resort. Post-trial assessment systems are also being increasingly used, for purposes such as assisting with sentencing decisions or prisoner release. In England and Wales, the Prison and Probation Service has developed and operates the Offender Assessment System (OASys), an automated risk-assessment tool.50 It assesses the risk of harm offenders pose to others and how likely an offender is to reoffend, as well as assessing offender needs. These risk assessments are used to decide ‘interventions’ and to influence the sentence plans given to offenders.51 Millions of these assessments have been carried out.52 The system collates information on offenders’ previous offences, education, training, employment, alcohol and drug misuse; as well as their ‘attitudes’, ‘thinking and behaviour’, ‘relationships’, and ‘lifestyle’.53 This data is used alongside the individual’s offending record and ‘offender demographic information’ to inform two predictive algorithms: OASys General Reoffending Predictor (OGP1) and OASys Violence Predictor (OVP1).54 A 2014 National Offender Management Service analysis found that the OGP1 and OVP1 generated different predictions based on race and gender. They found that relative predictive validity was better for white offenders than for Asian, black, or mixed ethnicity offenders. The Offender Group Reconviction Scale (OGRS) is another algorithmic risk assessment tool, which is used in England and Wales to assess and predict an offender’s likelihood of reoffending.55 The OGRS algorithm uses data on the individual’s official criminal history, as well as their age and gender, to produce a risk score between 0 and 1 of how likely an offender is to reoffend within one or two years. The use of these AI systems in a post-trial setting, and the documented differences in predictive outcomes based on, among other factors, race, highlight the clear need for strict testing and monitoring of such systems. These systems used in a post-trial setting could very easily be transferred to a pre-trial risk assessment setting; the principles and aims of these systems and the data used are very similar. For example, the COMPAS system, mentioned above and considered in more detail below, was originally designed as a recidivism risk assessment tool, and is also used as a pre-trial risk assessment tool. 56 Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure they have the desired effect of reducing rates of pre-trial detention rates. AI systems should be designed to be non-discriminatory One of the most frequent criticisms of AI systems and their use in criminal justice systems is that they can lead to discriminatory outcomes, especially along racial and ethnic lines. The best-known example of this is a study by the US media outlet ProPublica into COMPAS, a risk assessment tool designed to predict the likelihood of reoffending in Broward County in Florida. ProPublica found that COMPAS was 77% more likely to rate black defendants as ‘high-risk’ than white defendants, and it was almost twice as likely to mislabel white defendants as lower risk than black defendants.57 The dangers of the failure to adequately regulate the use of AI to prevent discrimination have also been witnessed in Europe. The ‘Crime Anticipation System’ (‘CAS’), a predictive policing software being used across the Netherlands, was initially designed to consider ethnicity as a relevant factor for determining the likelihood of a crime being committed. Amongst the indicators used by CAS to predict crimes in a particular area was the number of ‘non-Western allochtones’ in the area – in other words, ‘non-Western’ individuals with at least one foreign-born parent.58 The software not only presupposed the existence of a correlation between ethnicity and crime, but also singled out a category of ethnicities to be of particular concern, given that the presence of ‘Western’, ‘autochtone’ individuals were not used as indicators. Furthermore, given that ‘Western’ was defined somewhat subjectively (for example, including individuals of Japanese or Indonesian origin, and including all European nationalities, apart from Turkish), CAS incorporated highly questionable societal categorisations and biases. In the United Kingdom, a major criticism of HART has been that it included data collated and classified by a private company for marketing purposes that could very easily to biased outcomes. HART relied on the ‘Mosaic’ code developed by a consumer credit reporting company, that categorised individuals into various groups according to inter alia their ethnic origin, income, and education levels. It was of particular concern that some socio-demographic categories used by Mosaic were blatantly racialised, including, for example, ‘Asian Heritage’, which stereotyped individuals of ‘Asian’ origin as being unemployed or having low-paid jobs, and living with extended families.59 In Denmark, an automated algorithmic assessment has been used to classify different neighbourhoods, based on criteria such as unemployment, crime rates, educational attainment, and other ‘risk indicators’, as well as whether the levels of first and second-generation migrants in the population is more than 50%. Neighbourhoods which meet these criteria are classified as ‘ghettos’. These neighbourhoods are then subject to special measures, including higher punishments for crimes.60 It is clearly discriminatory, as well as entirely unfair, for people living in certain areas to be punished more severely than others in different areas for the same crimes. Further examples of criminal justice AI which have been identified as producing discriminatory outcomes include the previously mentioned OASys, NDAS and the Gangs Matrix in the UK, and the Netherland’s ProKid 12. These examples illustrate the need for regulations to ensure that AI systems are designed to be non discriminatory, and to exclude categorisations and classifications that deepen and legitimise social biases and stereotypes. However, policy makers should not assume that making AI systems blind to all protected characteristics will always help to produce non-discriminatory outcomes. In certain scenarios, the removal of protected characteristics from the data could worsen discrimination. For example, it has been suggested on the basis of research into COMPAS in the United States, that excluding gender as a variable for risk assessments would fail to reflect a well-established statistical fact that in most countries, women are less likely to reoffend than men.61 Making COMPAS gender blind would unfairly and inaccurately assume women to be as equally likely to reoffend as men, and discriminate against them by overestimating their risk scores. Removing visible biases from AI systems cannot be the sole or primary solution to their discriminatory impact, because AI systems can be biased even if they have not been deliberately designed in that way. Bias is often unintentional, and even if the AI system appears on the surface to be neutral, their algorithms can lead to discriminatory assessments and outcomes. COMPAS, for example, does not include race or ethnicity as a variable, yet research has found that it consistently gives black defendants higher risk scores than their white counterparts, making them less likely to be released from detention.62 Hidden biases can arise in AI systems in numerous ways. Although a comprehensive analysis of how they can cause unintentional biases are beyond the scope of this paper,63 the way in which AI systems are themselves created and built illustrate the difficulty, complexity, and sometimes impossibility, in preventing discriminatory outputs and effects of AI systems. There are fundamental issues with the way AI systems are designed and created which can lead to bias. Where the AI system is based on machine-learning, biases can result from faults in the data that is used to train its algorithms. Machine learning systems ‘learn’ how to make assessments or decisions on the basis of their analysis of data to which they have previously been exposed. However, the data used to train a machine learning system might be incomplete, inaccurate, or selected for improper reasons, and this could lead to AI systems producing unwanted outcomes. What amounts to appropriate, good quality data for the purpose of training algorithms depends on what the machine learning system is being designed to do,64 so it might not always be obvious which dataset is needed to train algorithms to be non-discriminatory. AI designed or created for use in the criminal justice system will almost inevitably use data which is heavily reliant on, or entirely from within, the criminal justice system itself, such as policing or crime records. This data does not represent an accurate record of criminality, but is merely a record of policing – the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data might not be categorised or deliberately manipulated to yield discriminatory results, but it may reflect the structural biases and inequalities in the society which the data represents. Where there are discriminatory policing patterns targeting certain demographics, or the systematic under-reporting and systematic over-reporting of certain types of crime and in certain locations,65 the use of such data merely results in a reinforcing and re-entrenching of those inequalities and discriminationin criminal justice outcomes. For example, according to UK crime data, black people are over 9 times more likely to be stopped and searched than white people,66 and black men are more than 3 times more likely to be arrested than white men.67 Despite these statistics, NDAS (mentioned above) in the United Kingdom explicitly relies on stop and search data to determine an individual’s propensity to commit a criminal offence. The fact that stop and search is disproportionately used against black people means that there will inevitably be an overrepresentation of black people in NDAS and that their risk levels will be inflated in comparison to white people. Comparable statistics on stop and search are not available in most EU Member States, where the official collection of racially disaggregated criminal justice data is either forbidden by law, or not standard practice. However, recent studies show that racially biased policing practices are prevalent throughout the EU. Data collected from a survey by the Fundamental Rights Agency, for example, has shown that during a 5-year period, 66% of individuals of Sub-Saharan African origin in Austria, and over half of respondents of South Asian origin in Greece were stopped and searched.68 AI built on data embedded with such biases and used to assist, inform, or make decisions in the criminal justice system, can expand and entrench the biases represented in the data.69 When AI systems result in criminal justice outcomes which repeat the discrimination inherent in the historic data, such as targeting individuals from a particular demographic, that decision will itself be preserved in the data. This leads to self-perpetuating ‘feedback loops’ which reinforce patterns of inequality.70 Another way in which AI systems can produce unintentional biases is by way of proxies. Data used by AI systems might be classified in seemingly legitimate ways, but those classifications can sometimes act as proxies for protected characteristics. A common example used to illustrate this point is how home addresses or postcodes can be proxies for race or ethnicity.71 Certain AI systems, such as HART, were initially trained to find correlations between home addresses and the risk of reoffending – in other words, to identify which postcode areas have ‘higher-risk’ residents than others.72 This approach overlooks the fact that there is very pronounced ethnic residential segregation in many countries,73 making it highly probable in practice, for AI systems to inadvertently establish a link between ethnic origin and risk. Roma are especially vulnerable to this form of proxy discrimination, given that in many EU Member States, Roma are reported to live primarily in segregated areas inhabited mostly or exclusively by Roma.74 There are several ways in which AI systems can be designed to mitigate the risks of discrimination, including by identifying and excluding data classifications that act as proxies for protected characteristics.75 However, it can be difficult in practice to identify which variables are proxies for protected characteristics (and how they do so), and removing too many ‘offending’ variables might result in the AI system losing much of its functional utility.76 There is no one-size-fits-all method of ensuring that AI systems do not produce discriminatory outcomes. Different approaches to de-biasing AI systems can conflict with one another, and the suitability of a particular de-biasing method might depend on the AI tool itself, and the legal and policy context in which it is designed to operate.77 Biases in AI systems are often not easy to detect and, in many cases, it might also be difficult to pinpoint flaws either in the system itself, or in the training data that has been caused the bias. The structural bias within the data that AI systems are built and operated on, a bias which is particularly deep-rooted in criminal justice data, is a fundamental issue, and one which is likely to result in AI systems being fundamentally inoperable – both because the bias makes them morally and ethically inoperable, if not yet legally, and because any attempts to remove the bias will make the data to operate these systems unusable. Fair Trials’ view is that the only effective way in which AI systems can be regarded as non discriminatory is if they have been subject to rigorous independent testing for biases. These tests must be mandated by law, must be independently run, have clearly stated aims or objectives, and be carried out pre-deployment to reduce the likelihood of individuals being affected by discriminatory profiling and decisions. AI can be tested in advance of deployment by using test data – datasets which are either synthetic datasets,78 or by using historic data with permissions – running it through an AI system, and analysing the outputs.79 For example, a trial of retrospective facial recognition video analysis is being run by a police oversight Ethics Committee in the UK. The trial is using historic data – CCTV footage – as the basis for simulated investigations in a controlled environment, monitored by researchers. The trial has clearly stated aims and signifiers of success, and all outcomes will be examined. There are significant human rights, data protection and ethical concerns involved with this particular technology, including the right to privacy, and the testing is not being conducted independently as it should be but, as above, there are positive aspects of the testing methodology.80 An alternative could be to ‘test’ a system in a strictly academic sense by running it alongside actual criminal justice processes, but with the system not having any effect on decision-making, and analysing the system’s proposed decisions or outcomes for bias. AI should never be used or even ‘tested’ in real-world situations where they have actual effects on individuals or criminal justice outcomes, before they have been tested. These types of tests also need to be carried out in the broader context of an AI governance framework that not only analyses the potential impact of the AI system pre-deployment, but also continues to monitor its impact afterwards. If these tests are not carried out, and/or if an AI system cannot be proven to be non-discriminatory, it should be legally precluded from deployment. However, as explained in the final section of this paper, it is questionable whether such tests are feasible in many Member States, where local laws prohibit the collection of racially-disaggregated data. AI systems should be developed to generate non-discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race or ethnicity. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. If an AI system cannot be proven not to generate discriminatory outcomes, it should not be used. AI Systems need to be transparent and explainable AI systems can have a significant influence over criminal justice decisions, and they should be open to public scrutiny in the same way that all decision-making processes by public entities should be. However, a common criticism of many AI systems is that they lack transparency, which often makes it difficult, if not outright impossible, to subject them to meaningful impartial analysis and criticism. This lack of transparency is both as a result of deliberate efforts to conceal the inner workings of AI systems for legal or profit-driven reasons, and of the nature of the technology used to build AI systems that is uninterpretable for most, if not all humans. There are several reasons why it is necessary for AI systems to be transparent. Firstly, transparency is essential for strengthening confidence of both primary users of the system, as well as the general public, in AI systems. Democratic values demand that the public needs to be aware of how powerful public institutions, such as the police and the judiciary, operate so that they can be held accountable for their actions. It is also crucial for primary users of AI systems to understand how they work, so that they can make informed decisions about how much influence they should have on criminal justice decisions. Secondly, decisions made by AI systems need to be contestable at an individual level. Standards on the right to a fair trial and the right to liberty demand that defendants should have access to materials that inform decisions regarding them, so that they can challenge the accuracy and lawfulness of those decisions. Transparency also acts as a safeguard against bias and inaccuracies. It is difficult to imagine how issues that undermine the fairness and accuracies of AI systems (such as racial biases) can be detected, and ultimately fixed, if they cannot be properly accessed and analysed. As explained above, certain AI systems, such as CAS, have been found to have serious, but very obvious, flaws. In CAS’s case, however, the fault in the software could be detected easily, which meant that the discriminatory impact of the tool could be mitigated. The indicator for ‘non-Western allochtones’ in CAS was removed in 2017,81 ostensibly because it served no useful purpose, but presumably also because of the very obvious bias. This mitigation was possible because CAS is a transparent software, that was developed in-house by the Dutch police. The types of indicators used to predict crime were made openly available, and information about the method by which the software made predictions could easily be accessed and understood.82 This, however, is not the case for all AI systems, because AI systems are often developed by for-profit companies with little to no meaningful input from the public. As such, details of how they are designed, and how they make decisions and assessments are, in many cases, closely guarded as trade secrets that are protected by law.83 Often, AI systems are ‘black boxes’ because they are deliberately kept that way. While it is accepted that strong, enforceable intellectual property laws are needed to promote advancements in what is a very dynamic field of scientific research and innovation, it is not acceptable that these concerns trump the rights of individuals suspected or accused of crimes. In light of this, it is concerning that the Commission’s White Paper focuses on, and strongly promotes, the concept of a ‘partnership between the private and the public sector’ in relation to AI.84 Fair Trials appreciates that effective public-private collaboration could help to fill in gaps in public sector expertise and capacity for the development of AI systems, but given the transparency challenges, it is essential thatsuch partnerships are accompanied by robust regulations and rules that ensure effective and open scrutiny. However, even if AI systems are completely exposed to public scrutiny, and their source code85 and input data, for example, are openly disclosed, there is still no guarantee that they will be sufficiently transparent to enable adequate independent scrutiny. AI systems can be black boxes by nature of the technology that makes their decision-making processes complicated beyond comprehension for most (in some cases, too complicated even for computer scientists to understand).86 This is especially the case where AI systems are based on machine-learning algorithms. One possible reason for the unintelligibility of AI systems is that they sometimes use machine-learning algorithms that are simply too complex to be understood to a reasonable degree of precision.87 This is especially the case where AI systems incorporate ‘Deep Neural Networks’ – a machine-learning algorithmic architecture inspired by the structure and mechanics of human brains. Rather than relying on a set of man-made instructions, these types of AI systems make decisions based on experience and learning. Decision-making processes of this kind have been described to be ‘intuitive’, because they do not follow a defined logical method, making it impossible to analyse the exact process by which a particular decision is reached.88 It has also been suggested that some AI systems are uninterpretable to humans because the machine-learning algorithms that support them are able to identify and rely on geometric relationships that humans cannot visualise. Certain machine-learning algorithms are able to make decisions by analysing many variables at once, and by finding correlations and geometric patterns between them in ways that are beyond the capabilities of human brains.89 Given these challenges, there is widespread recognition that states should require AI systems to not only be ‘transparent’, but also explainable and intelligible.90 GDPR already recognises that individuals should have the right to an explanation of how a decision was reached, if they have been subject to an automated decision.91 In principle, this is an essential and very useful requirement, but it is also one that seems difficult to implement in practice, given that both ‘explainability’ and intelligibility are highly subjective concepts. Arguably, AI systems’ computing processes are inherently difficult to explain and understand for most people, including for most criminal justice decision-makers, but this surely should not be the sole basis for oversimplifying the technology, or for banning the use of AI outright. Computer scientists have been theorising different ways of ensuring that decisions made through complex algorithms can be explained and understood. An example is the ‘explainable AI’ movement (‘xAI’) that aims to build AI systems that can show more discernible links between inputted data and decisions. xAI systems measure how each input influences the final decision, so it is possible figure out how much weight is given to each input.92 This seems to be an innovative response to the ‘black box’ challenge, establishing clearer, more helpful relationships between inputs and final decisions. However, it appears to fall short of explaining what happens between data being inputted into the system and the final decision, and it does not enable users to impute any logic to the decision-making process.93 As explained above, there are various reasons why AI systems need to be transparent and intelligible, but the effective of exercise of the rights of the defence must be recognised as a crucial test for determining whether an AI system is sufficiently explainable and intelligible. AI systems have to be designed in a way that allows criminal defendants to understand and contest the decision made against them. Partnership for AI has suggested that a central factor that determines the contestability of AI systems is the possibility of carrying out an audit trail of the AI decision.94 In particular, it has to be possible for an auditor to follow and reproduce the process and come to the same conclusion reached by the AI system at the end. Furthermore, as explained in further detail below, criminal justice procedures should require the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings, and this disclosure should be in a form which is understandable to a layperson, without the need for technical or expert assistance. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, as well as the general public. Commercial or proprietary interests, or technical concerns, should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decision made against them. It should be possible to carry out an independent audit, and processes should be reproducible. Part 2: Safeguards for the use of AI Systems in Criminal Proceedings AI systems have to be built in accordance with human rights principles, and to give effect to human rights in practice, but it is unlikely that their design alone will guarantee that they are used in ways that comply with human rights. Regulatory frameworks for the design and deployment of AI systems have to be accompanied by appropriate legal safeguards that ensure they are used responsibly and lawfully. There are two primary questions that need to be addressed: 1) how procedural rules ensure that decision-makers do not over-rely on AI systems; and 2) how decisions and assessments made by AI systems can be analysed independently and challenged. Combatting ‘Automation Bias’ and Reinforcing Meaningful Human Input One of the main challenges of automated, or semi-automated decision-making systems is that of ‘automation bias’ – the tendency to over-rely on automation in ways that can cause errors in decision making. Automation bias occurs primarily due to the perception that automated decision-making processes are generally trustworthy and reliable. Automated cues have been found to be particularly salient to decision-makers, and research has shown that users of automated decision-making systems have a tendency to place greater weight on automated assessments over other sources of advice.95 The disproportionate influence of automated systems can undermine the quality of decision-making, by discouraging its users from consulting a wider range of factors that could inform more accurate decisions. Most AI systems currently being used to assist criminal justice decision-making do not completely replace human decision-making. They are instead designed and deployed to be used as decision aids, whose outputs are factored into consideration for the purposes of human decision-making. The phenomenon of automation bias however, raises questions about whether AI systems are being used in reality in accordance with their intended purpose as decision aids, and not as de facto replacements for human decision-making processes. There is strong evidentiary basis for automation bias amongst pilots who, like judges and other decision-makers in criminal justice proceedings, have typically been through a high level of training to make appropriate decisions in highly complex settings.96 However, limited research into automation bias amongst judges suggests that AI systems might have a more complex impact on judges’ behaviour. For example, a study conducted in 2019 in Kentucky seems to suggest that the degree to which judges rely on predictive tools for pre-trial detention decision-making could be influenced by the ethnicity of the defendant.97 The research indicates that judges had a greater tendency to rely on algorithmic risk assessments where the defendant was white, whereas in cases where the defendant was black, judges were more likely to overrule the risk-assessment in favour of detaining them. This study appears to show that AI systems can influence judges’ behaviour in unpredictable ways, especially where there are interactions or conflicts between automation and human biases, and that AI systems might be an ineffective tool for challenging human prejudices. It is crucial that rules governing the use of AI systems in criminal proceedings actively try to counter automation bias, and to encourage decision-makers to make independent determinations. A simple requirement to have a human decision-maker ‘in the loop’ or to have a human decision-maker review or check the automated decision is insufficient, because this risks overestimating the capacity or willingness of human decision-makers to question and overrule automated decisions. A mere requirement to have an automated decision reviewed by a human, on its own, could reduce the human review into a rubber-stamping exercise which, in practice, is no oversight at all. In recognition of this challenge, the European Data Protection Board has recommended that in order for decisions to be regarded as not ‘based solely’ on automated processing for the purposes of Article 22 GDPR, there has to be ‘meaningful’ human oversight, rather than just a token gesture.98 What qualifies as ‘meaningful’ intervention is open to interpretation, and it is likely to differ depending on the circumstances and the type of decision being made. In the context of criminal justice procedures, where decisions often have particularly severe and far-reaching implications for individuals’ rights, safeguards for ensuring meaningful human intervention have to be especially robust. Procedural safeguards that ensure ‘meaningful’ human oversight Rules governing the use of AI systems in criminal justice proceedings have to counter automation bias by encouraging human decision-makers to treat their processes with scepticism, and to force them to challenge and scrutinise the outcomes of algorithmic assessments. Procedural safeguards that can be put in place to tackle automation bias include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easier for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. One way of ensuring that automated assessments and decisions do not have undue influence on judicial decisions might be to ensure that decision-makers are sufficiently informed and alerted about the risks of relying on AI systems. This seems to be the approach taken by the Wisconsin Supreme Court in the United States in the case of Loomis,99 in which the Court considered whether or not the use of the COMPAS risk assessment tool for sentencing purposes violated due process rights. The judgment in Loomis recognises the importance of procedural safeguards as a way of safeguarding fairness of decisions, by requiring the use of ‘written advisements’ to alert decision-makers about the potential risks of AI risk assessments. Specifically, the court mandated that these advisements had to include warnings that: a) the process by which the COMPAS produces risk scores were not disclosed due to its ‘proprietary nature’; b) the accuracy of risk scores are undermined by the fact that COMPAS relied on group data; c) the risk-assessment tool had never been tested locally for accuracy; d) ‘questions’ have been raised about the discriminatory effect of COMPAS risk-assessments; and e) COMPAS was developed to inform post-sentencing decisions, but not sentencing decisions themselves. These warnings are clearly very specific to COMPAS and the context in which it is used in Wisconsin. If similar safeguards were adopted in different contexts and with regard to different AI systems, advisements will no doubt need to be adapted. The warnings used in Loomis have, however, been criticised because they do not give enough information to decision-makers to enable them to appreciate the degree to which these risk-assessments should be discounted.100 In particular, the advisements are silent on the strength of the criticisms against COMPAS, and they say nothing about the basis on which questions about their discriminatory effect have been raised.101 These warnings also give no indication about likely margin of error of the assessment, so although judges are informed that some assessments might be inaccurate, they are not in a position to appreciate how serious or frequent these errors might be. ‘Advisements’, or warnings that encourage decision-makers to be sceptical of AI systems cannot be considered as effective safeguards, unless they contain sufficiently helpful information for decision makers. However, even if judges are given stronger warnings than those in the Loomis advisements, it is still doubtful whether they alone will adequately mitigate automation bias. One reason for this is that many criminal justice decisions (such as pre-trial detention decisions) are, in practice, made very routinely by judges. Although written advisements might initially help judges think more critically about automated risk assessments, over time, these advisements could become repetitive and routine, and lose much of the intended meaning and effect.102 An effective safeguard that could work in conjunction with mandatory warnings could be for decision makers to be given a better insight into how AI systems produce a particular assessment or calculation. As mentioned above, the lack of information about how assessments are made by AI systems makes it harder for criminal defendants to scrutinise and challenge them. Surely, this has to be true also for decision-makers. It is much harder, if not impossible, to analyse and criticise decisions if there is no reasoning behind them. While AI systems do not rely on ‘reasoning’ per se, information given to decisions about how a specific assessment was made, including what factors were relevant, and how much weight was given to each factor could give decision-makers more confidence to decide whether to agree or disagree with an AI-generated decision. Decisions or assessments made by AI systems cannot be the sole basis of criminal justice decisions – they should be no more than a factor that can influence human-decision making. As such, decision makers should be required to show that decisions were influenced by a broader range of factors other than the AI system, by way of fully reasoned, case-specific, written decisions. Research has shown that the lack of case-specific reasoning in pre-trial detention decisions is already a serious challenge in many EU Member States,103 and AI systems risk worsening the standardisation of such decision making processes. Where AI systems are used to inform pre-trial detention decisions, or any other criminal justice decision that has a significant impact on the rights of the defendant, reasoned decisions must be specific to the defendant’s case, and in particular, they must reveal what which factors influenced the decision, and to what degree. In particular, decisions have to make it clear how much weight was given to assessments by AI systems. It is also crucial that decision-makers are able to override decisions made by AI systems, and that they are confident about doing so where the tool produces assessments or recommendations that are unfavourable to the defendant (e.g. where the AI system advises against releasing the defendant). It has been reported that members of the police force in Avon and Somerset Police in the United Kingdom are expected to record incidences where they have disagreed with assessments made by a predictive policing tool, and to explain their reasons for the disagreement.104 This is likely to act as a strong disincentive for overriding decisions made by the AI system, and as such, it actively facilitates automation bias. Furthermore, it seems to interfere with the presumption of innocence by making it difficult for decision-makers to override AI systems to make decisions that favour the defendant. If an AI system recommends the arrest or the detention of an individual, decision-makers should feel that they have a genuine choice of overruling the AI system, and not be pressured into compliance. Criminal justice decision-making processes should, as a general rule, be skewed in favour of the defence to give effect to the presumption of innocence, and rules governing the use of AI systems should favour favourable outcomes for defendants. On the other hand, in cases where a decision-maker acts against the advice of an AI system that recommends a favourable outcome for the defendant, there should be a requirement for reasons to be given for their decision. This is to prevent unfavourable outcomes for defendants that are motivated by improper reasons, and to mitigate the risk of unconscious bias. Challenging AI in criminal proceedings AI systems need to be contestable by criminal defendants. This is so that they can not only challenge the outcomes of the AI systems’ calculations and analyses, but also scrutinise the legality of their use. In other words, being able to challenge AI systems in criminal proceedings is not only a procedural fairness requirement for defendants, it is also a means by which legal standards governing AI systems and their use can be enforced. One of the major issues preventing the sufficient contestability of AI systems in criminal proceedings is the lack of notification. If an individual is not notified that they have been subject to an automated decision by an AI system, they will not have the ability to challenge that decision, or the information that the decision was based on. For example, in the United Kingdom, the Data Protection Act 2018 sets out the applicability of the GDPR and sets out the UK’s interpretations of the GDPR’s requirements and safeguards. However, section 14 of the Data Protection Act significantly dilutes the requirements of Article 22 of the GDPR, permitting purely automated decisions which have legal or similar significant effects on a data subject, without their consent, as long as the data subject is subsequently notified that a purely automated decision has been taken about them, after the decision has been made. It is only then that the data subject has the opportunity to request a new decision. However, it has been reported that individuals subject to decisions by the HART system in the UK are not notified at all that they have been subject to such an automated decision, even after it has been made.105 This is likely because under the Data Protection Act 2018, automated decisions which have legal or similar significant effects on a subject are not necessarily classified as ‘purely automated’ if a human has administrative input. In order to meet this requirement, the human input can be as minimal as checking a box to accept the automated-decision, even if it has a significant impact on an individual, such as holding them in custody. This minimal requirement for human requirement means that, in practice, decisions made with negligible to no meaningful human input can be classified as not “purely automated” and there is no legal requirement to notify and ability to request a new decision. In this way, systems such as HART continue to be used, with people subject to their decisions completely uninformed. While the GDPR already requires the notification of individuals affected by automated decisions, the UK’s experience with HART highlights the need for stricter rules to not only ensure meaningful human input (as mentioned above), but to also strengthen the individual’s right to be notified. There must be a requirement for individuals to be notified, not just for “purely automated” decisions, but whenever there has been an automated decision-making system involved, assistive or otherwise, that has or may have impacted a criminal justice decision. This notification should include clear and comprehensible information about the decision that has been taken, how that decision was reached, including details of the information or data involved in reaching that decision, what the result or outcomes of the decision are, and what effects, legal or otherwise they have, and information on how to challenge that decision. As discussed in the previous section, a further major barrier to the contestability of AI systems is a technical one. The ‘black box’ nature of certain AI systems can be largely attributed to their design, so it is important that there are rules governing the interpretability of these systems so that when they are in use, their processes can be understood at all. However, there are also legal barriers to the full disclosure of AI systems, which are often put in place to protect commercial interests. Procedural safeguards play a particularly important and effective role in addressing these types of opacity challenges. Transparency is a fundamental aspect of an adversarial process that underpins the right to a fair trial, and human rights standards require that as a general rule defendants should be given unrestricted access to their case-file,106 and to be given the opportunity to comment on the evidence used against them.107 These standards are further reinforced by Directive 2012/13/EU,108 which requires Member States to grant access to all material evidence in possession of the competent authorities to the defence to safeguard the fairness of the proceedings and to enable defendants to prepare their defence.109 The procedural requirement of an adversarial process is not one that is limited to substantive criminal proceedings – it also applies in the context of pre-trial decision-making processes, especially for decisions on the deprivation of liberty.110 While EU law and international human rights law also recognise that there might be certain justifications for non-disclosure of materials used against the defendant in criminal proceedings, these are narrow restrictions, and commercial interests are not regarded as a valid justification for non-disclosure.111 Furthermore, EU law does not explicitly recognise any derogations from the right of access to materials that are essential to challenging the lawfulness of an arrest or detention.112 In order for Member States to comply with these standards, any exceptions to the disclosure of information regarding AI systems have to be applied very narrowly. Barriers to scrutiny and accountability of AI systems are not only legal, but also technical. As explained in previous sections, many AI systems suffer from interpretability issues because of their design and by the nature of the machine-learning technology upon which they rely. In the absence of specific expertise on AI, it is difficult to imagine how, in practice, defendants and their lawyers will be able to challenge AI systems. One possible solution to this challenge, as explained below, is training for defence lawyers – but it is unreasonable to expect lawyers to develop expertise that would enable them to analyse and scrutinise AI systems at a technical level. A further solution could be that defence lawyers have access to the relevant expertise from suitably qualified professionals. However, in reality, not all criminal suspects and accused persons are able to access the legal and other technical assistance needed to understand and challenge technically complex AI systems, for financial or other practical reasons. It would also be unreasonable and unrealistic to require all suspects and accused persons to engage technical expertise just to be able to understand how an AI system makes a decision, especially where AI systems are used routinely or mandatorily to make or assist criminal justice decisions. It might seem unreasonable to expect all highly technical evidence to be challengeable by lay defendants without the help of a suitable expert. However, AI systems are not necessarily used in criminal proceedings as ‘evidence’, and in practice they could be an integral part of a decision-making process, or even a replacement for it. As such, it is essential that the ‘reasoning’ of AI systems are made known to suspects and accused persons, similarly to how judicial decisions must contain “sufficient reasoning and address specific features of a given case”, especially where they concern the deprivation of liberty.113 Decision-making processes of AI systems and the way in which it has produced an outcome in a particular case should thus be disclosed to suspects and accused persons, in a form that is intelligible to a layperson. Individuals should not need to rely on experts to simply understand how a decision affecting them was made. While there will inevitably be scenarios where defendants would need expertise to challenge an AI-assisted decision, but these cases should be the exception, rather than the norm, for whenever an AI system is used. Criminal justice procedures should require the notification to suspects and accused persons where an AI system has been used which has or may have impacted a decision made about that individual. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is comprehensible to a layperson, without the need for technical or expert assistance, and suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training AI systems use technology not well understood by many people. Without proper training, outputs of AI systems might not be easy to interpret, and it might be difficult to appreciate which factors undermine the reliability of AI systems, so that appropriate weight can be attached to their findings. As mentioned above, decision-makers can be warned about the weaknesses of AI systems as part of their decision-making process, but the effectiveness of this safeguard can be questioned, because it is unlikely to provide decision-makers with all the information they need, and there is no guarantee that the warnings will be taken seriously in all cases. Training is not just needed for the primary users of AI systems, such as judges and police officers who use them to inform their own decisions. The training must also be available criminal defence lawyers, so that they are in a better position to challenge AI systems, where necessary. If AI systems are used routinely to aid criminal justice decisions or even made mandatory (as is the case in certain states in the United States), there would be strong justification for governing bodies to make training on AI mandatory for criminal justice practitioners. Part 3: Governance and Monitoring Criminal justice processes are an important enforcement mechanism for ensuring that AI systems are designed and used lawfully, but they cannot be the sole, or even the primary means of implementing legal and ethical standards. Of equal, if not greater importance is a framework that ensures that policy decisions on the design and deployment of AI systems are made in systematised way, and that unlawful or harmful AI systems never enter into public service. Member States that deploy AI systems for criminal justice purposes should have regulatory mechanisms that are fit for purpose. At a minimum, these should include frameworks for: a) pre-deployment impact assessments; b) post deployment monitoring and evaluations; and c) collection of data needed for effective comparative analysis. Pre-Deployment Both the GDPR and LED recognise the need for AI systems to be analysed before they are deployed, so that they comply with existing regulatory and human rights standards. Under Article 35 GDPR, Member States are required to carry out a ‘Data Protection Impact Assessment’ (‘DPIA’) for data processing systems that carry out ‘a systematic and extensive evaluation of personal aspects relating to natural persons which is based on automated processing, including profiling and on which decision are based that produce legal effects concerning the natural person or similarly significantly affect the natural person’. The corresponding provision in the LED is Article 27, which similarly calls for DPIAs to be carried out where processing of data is likely to result in a ‘high risk to the rights and freedoms of natural persons’. DPIAs under both laws have to carry out inter alia an assessment of the possible impact of the data processing system on the rights or individuals, and they need to mention what measures will be in place to ensure that their rights are properly protected. DPIAs help to address a serious accountability challenge, but EU laws do not provide sufficiently helpful standards on how they should be conducted. Article 27 LED does not lay down minimum requirements for how DPIAs should be carried out. On the other hand, there are aspects of Article 35 GDPR which, if used to guide how DPIAs should be conducted for AI systems used in criminal justice, would raise concerns. The foremost challenge is the level of transparency mandated by the GDPR. DPIAs are envisaged largely as internal processes led by the data controller, who may seek the opinions of data subjects (such as members of the public or their representatives), where it is ‘appropriate’ to do so. The GDPR also explicitly recognises that the requirement to seek the views of data subject is ‘without prejudice to the protection of commercial interests’.114 As outlined above, transparency is a key aspect of a fair criminal justice system and, as a general rule, all criminal justice decision-making processes need to be open to public scrutiny. There is no reason why AI systems should be exempt from this requirement and, given that administration of criminal justice is a matter of strong public interest, the public should have the right to voice their opinions and raise objections whenever AI systems impact criminal justice processes. Also, given the highly technical nature of AI systems, and their (as yet) poorly understood impact on society, impact assessments must have multi-disciplinary expert engagement. 115 In particular, DPIAs should always involve independent experts (computer scientists, in particular) who can audit, analyse, and if possible, ‘explain’ AI systems, so that they can help legal, policy and social science experts to determine the likely implications for the individuals’ rights. For public and expert consultations to be meaningful and effective, sufficient information should be made available to interested parties so that the AI system can be thoroughly understood and researched. Partnership on AI has recommended that for criminal justice risk-assessment tools, training datasets,116 architectures and algorithms of AI systems should be made available to ensure meaningful scrutiny.117 Commercial interests should not be regarded as a legitimate ground for limiting the disclosure of this information. Secondly, Article 35 GDPR allows data controllers to carry out a single DPIA ‘for a set of similar processing operations that present similar high risks’. There is a danger that this provision could be interpreted too broadly if Member States are given free rein to determine what two systems can be regarded as sufficiently ‘similar’. There are risks in assuming that an AI system well-suited for use in a particular context or within a particular geographic area will be equally useful in another. AI systems built using data from one jurisdiction might not be able to reflect differences in, for example, law enforcement culture and patterns of behaviour, laws and policies, and socio-demographic characteristics of another jurisdiction.118 Sometimes, these differences can be seen in the same country or even within the same region. For example, a study of ‘PRECOBS’ a predictive policing tool used in Baden-Wurttemberg in Germany, found significant differences in predictive utility between rural and urban areas.119 Finally, DPIAs seem to require data controllers to theorise the possible impact of AI systems, but there is no strict requirement for AI systems to be subject to testing or auditing before, or immediately after deployment. This overlooks the fact that flaws in AI systems, including unintentional biases, are not always easily detectable, and that they might only surface once the system is put into operation. As discussed earlier, the causes of biases in AI systems can be difficult to identify, and it is difficult to appreciate how, short of thorough testing, the true impact of AI decisions can be known. In New York, the AI Now Institute has proposed an alternative model for impact assessments, known as ‘Algorithmic Impact Assessments’ (‘AIAs’).120 The AIA framework sets out in detail how public authorities should conduct impact assessments of AI systems, and it can be contrasted with the provisions of the GDPR in that AIAs place much greater emphasis on the need for community engagement and consultations with external experts. This framework could serve as a useful guide for Member States seeking to establish pre-deployment procedures for approving AI systems. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. AI systems must be tested for impact pre-deployment, and systems should be precluded from deployment until they have undergone this testing and achieved minimum standards, such as non-discrimination. Post-Deployment Impact assessments of AI systems should not be regarded as ‘one-off’ processes. They have to be followed up with ongoing post-deployment monitoring and evaluation, so that the longer-term impact of AI systems can be understood, and shortcomings and biases that affect the rights of individuals can be identified and fixed. The ability of AI systems to deliver fair and just outcomes, and to meet policy objectives can be difficult to predict from the outset. Although AI systems can be validated and tested prior to deployment to check if they are likely to produce desired outcomes, their impact in the real world might be different. Furthermore, even if the likely outputs of AI systems can be predicted, it is much harder to estimate the likely impact they will have on human decision-making.121 Further reviews of AI systems are also necessary because criminal justice systems and the societies in which they operate change over time. A study in the United States, for example, theorises that many pre-trial risk assessment tools might be making predictions based on historic data that is no longer fit for purpose. It has been suggested that because data used to train risk assessment algorithms pre date bail reforms in many US jurisdictions, the impact of recent measures introduced to reduce the risk of failure-to-appear, such as transportation assistance and text message alerts are not taken into consideration – potentially leading to over-incarceration.122 Socio-demographic changes might also require AI systems to be altered so that they continue to be fit for purpose. If, for example, an area experiences high levels of net migration which results in rapid changes to policing patterns and judicial behaviour, AI systems might need to be reviewed to make sure they are not unintentionally worsening racial discrimination. Data Collection It is difficult to imagine how the impact of AI systems can be assessed, if there is inadequate data to support effective monitoring. The deficiency of criminal justice data across the EU has been subject to criticism. In particular, Fair Trials has found that most EU Member States do not systemically collect statistics on the duration of pre-trial detention, outcomes of criminal cases of pre-trial detainees, and the likelihood of a suspect or accused person being released by the court.123 The data needed for effective monitoring and evaluation depends on the function of the AI system and its intended objectives, but the lack of criminal justice data more generally questions whether Member States currently have adequate legal and policy foundations for introducing AI systems responsibly into criminal justice processes. Data needed for monitoring and evaluation purposes will, of course, need to have been collected from well before the introduction of the AI system, so that a proper pre- and post- analysis comparison can be made. Of particular concern is that in most EU Member States, race or ethnic data on criminal justice is not available, either because there is no systemised process for collecting it, or because local laws ban this practice altogether.124 This is a serious challenge because the most predominant criticism against the use of AI systems in the United States and elsewhere is that it worsens racial and ethnic bias in criminal justice decisions. Even without official statistics, there is strong evidence in many EU Member States that certain ethnic minorities, and in particular, Roma and people of colour are unfairly overrepresented in criminal justice systems.125 It is worrying that AI systems might worsen this discrimination, but that there will be no way of detecting this trend, because of the lack of data. Furthermore, the absence of racial and ethnic data could also prevent pre-emptive measures to combat racial bias. It is doubtful that developers will be able to design systems free from racial bias, if they have no data against which to measure their performance. On data collection, Fair Trials believe that EU and its Member States will need to make a strict choice. Either they should ensure that racially disaggregated criminal justice data is collected, or AI systems should be banned where they make individualised assessments for criminal justice purposes. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity.
USER:
What are some examples of visible and hidden biases that have been observed in criminal justice AI?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 17 | 16,453 | null | 90 |
You must answer questions based exclusively on the information provided in the prompt. You can not use external resources or prior knowledge.
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What are the key differences between each clinical trial phase?
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Clinical Trial Phases Phase 1 Trials. Phase 1 trials are the first time the product is introduced in human subjects. These carefully controlled trials typically involve 20 to 80 patients or volunteer subjects, though the exact numbers may vary depending on the product. Phase 1 trials generally assess how the product acts in the body and evaluate initial safety (i.e., side effects). They may also be used to determine the dosing levels to use in phase 2 (e.g., the maximum safe dose or what dose is required to have an effect). Depending on the product, phase 1 trials may also provide some initial indication as to whether the product may be effective. In the case of vaccines specifically, phase 1 trials also assess their ability to provoke an immune response in the body (i.e., immunogenicity). Phase 2 Trials. Phase 2 trials continue to assess safety but also evaluate the product’s effectiveness and common short-term side effects or other risks associated with the product. Phase 2 trials are also used to determine the optimal dose of the product. For vaccines, phase 2 assesses how much of the vaccine to administer and on what dosing schedule (e.g., whether a boost is needed to maximize its effectiveness or whether the vaccine must be administered on a regular schedule to maintain immunity). As with phase 1 studies, phase 2 studies are carefully controlled. However, phase 2 involves a larger (though still relatively limited) number of volunteer subjects—generally no more than a few hundred participants. Phase 3 Trials. Phase 3 trials involve an expanded number of participants—from several hundred to thousands—and are used to assess the product’s safety and effectiveness across a wide range of patient categories through controlled and uncontrolled studies. These trials are intended to present a clearer picture of expected risks and benefits under real-world conditions. The information obtained from phase 3 trials also forms the basis for the product’s labeling. Sponsors must generally complete all three phases to obtain FDA approval unless they obtain accelerated approval, in which case FDA requires post-approval trials to confirm the expected clinical benefit. FDA may also require, at its discretion, additional clinical trials after approval (i.e., phase 4 trials) for any approved product to continue assessing the product’s safety and effectiveness once on the market.
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What are the key differences between each clinical trial phase? You must answer questions based exclusively on the information provided in the prompt. You can not use external resources or prior knowledge. Clinical Trial Phases Phase 1 Trials. Phase 1 trials are the first time the product is introduced in human subjects. These carefully controlled trials typically involve 20 to 80 patients or volunteer subjects, though the exact numbers may vary depending on the product. Phase 1 trials generally assess how the product acts in the body and evaluate initial safety (i.e., side effects). They may also be used to determine the dosing levels to use in phase 2 (e.g., the maximum safe dose or what dose is required to have an effect). Depending on the product, phase 1 trials may also provide some initial indication as to whether the product may be effective. In the case of vaccines specifically, phase 1 trials also assess their ability to provoke an immune response in the body (i.e., immunogenicity). Phase 2 Trials. Phase 2 trials continue to assess safety but also evaluate the product’s effectiveness and common short-term side effects or other risks associated with the product. Phase 2 trials are also used to determine the optimal dose of the product. For vaccines, phase 2 assesses how much of the vaccine to administer and on what dosing schedule (e.g., whether a boost is needed to maximize its effectiveness or whether the vaccine must be administered on a regular schedule to maintain immunity). As with phase 1 studies, phase 2 studies are carefully controlled. However, phase 2 involves a larger (though still relatively limited) number of volunteer subjects—generally no more than a few hundred participants. Phase 3 Trials. Phase 3 trials involve an expanded number of participants—from several hundred to thousands—and are used to assess the product’s safety and effectiveness across a wide range of patient categories through controlled and uncontrolled studies. These trials are intended to present a clearer picture of expected risks and benefits under real-world conditions. The information obtained from phase 3 trials also forms the basis for the product’s labeling. Sponsors must generally complete all three phases to obtain FDA approval unless they obtain accelerated approval, in which case FDA requires post-approval trials to confirm the expected clinical benefit. FDA may also require, at its discretion, additional clinical trials after approval (i.e., phase 4 trials) for any approved product to continue assessing the product’s safety and effectiveness once on the market.
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You must answer questions based exclusively on the information provided in the prompt. You can not use external resources or prior knowledge.
EVIDENCE:
Clinical Trial Phases Phase 1 Trials. Phase 1 trials are the first time the product is introduced in human subjects. These carefully controlled trials typically involve 20 to 80 patients or volunteer subjects, though the exact numbers may vary depending on the product. Phase 1 trials generally assess how the product acts in the body and evaluate initial safety (i.e., side effects). They may also be used to determine the dosing levels to use in phase 2 (e.g., the maximum safe dose or what dose is required to have an effect). Depending on the product, phase 1 trials may also provide some initial indication as to whether the product may be effective. In the case of vaccines specifically, phase 1 trials also assess their ability to provoke an immune response in the body (i.e., immunogenicity). Phase 2 Trials. Phase 2 trials continue to assess safety but also evaluate the product’s effectiveness and common short-term side effects or other risks associated with the product. Phase 2 trials are also used to determine the optimal dose of the product. For vaccines, phase 2 assesses how much of the vaccine to administer and on what dosing schedule (e.g., whether a boost is needed to maximize its effectiveness or whether the vaccine must be administered on a regular schedule to maintain immunity). As with phase 1 studies, phase 2 studies are carefully controlled. However, phase 2 involves a larger (though still relatively limited) number of volunteer subjects—generally no more than a few hundred participants. Phase 3 Trials. Phase 3 trials involve an expanded number of participants—from several hundred to thousands—and are used to assess the product’s safety and effectiveness across a wide range of patient categories through controlled and uncontrolled studies. These trials are intended to present a clearer picture of expected risks and benefits under real-world conditions. The information obtained from phase 3 trials also forms the basis for the product’s labeling. Sponsors must generally complete all three phases to obtain FDA approval unless they obtain accelerated approval, in which case FDA requires post-approval trials to confirm the expected clinical benefit. FDA may also require, at its discretion, additional clinical trials after approval (i.e., phase 4 trials) for any approved product to continue assessing the product’s safety and effectiveness once on the market.
USER:
What are the key differences between each clinical trial phase?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 10 | 383 | null | 445 |
Answer the question using only the given context block. Do not use any outside resources or prior knowledge. Format your answer in a paragraph with no more than 150 words. If you cannot answer using the context block alone, respond with "I'm sorry. I cannot find the answer in the context source."
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What limits the scope of Biden's pardon for marijuana possession?
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Federal Clemency for Marijuana Possession On October 6, 2022, President Biden issued a proclamation granting “a full, complete, and unconditional pardon” to “all current United States citizens and lawful permanent residents” who had committed or been convicted of simple possession of marijuana under the CSA or a related provision of the D.C. Code. President Biden’s invocation of the clemency power means that persons who committed simple possession of marijuana before the date of the proclamation may not be prosecuted or punished for the offense under the relevant provisions of the CSA or the D.C. Code. (Although the District of Columbia has its own criminal code, its criminal justice system has some overlap with the federal system and is subject to the President’s clemency power.) Several factors limit the scope of the pardon. First, it applies only to violations of federal and D.C. law and does not affect other state law marijuana offenses. In announcing the pardon, President Biden also encouraged state governors to take similar steps but, under the United States’ federalist system of government, the President has no direct power to change state law or compel the states to adopt federal policies. While some governors have taken similar steps or expressed willingness to do so, in some states, governors cannot independently grant clemency. Second, the pardon applies only to simple possession of marijuana, not to other marijuana-related CSA offenses such as manufacture, distribution, or possession with intent to distribute or to other federal crimes. Federal prosecutions of simple possession of marijuana are relatively uncommon. The U.S. Sentencing Commission (USSC) reports that about 7,700 people subject to the pardon were convicted of only simple possession since FY1992, none of whom are currently in federal custody. (Additional individuals not subject to the pardon were convicted during that period.) In FY2021, 117 people subject to the pardon were convicted of only simple possession. A smaller number of people were convicted of possessing marijuana and possessing other illicit drugs or committing other crimes. Those people would remain liable for the other offenses. Shortly after the pardon was announced, the USSC issued policy priorities including “consideration of possible amendments to the [Sentencing] Guidelines Manual relating to criminal history to address … the impact of simple possession of marihuana offenses.” Third, the pardon by its terms “does not apply to individuals who were non-citizens not lawfully present in the United States at the time of their offense.” According to a 2016 USSC report, the vast majority of federal marijuana possession arrests occur at the border between the United States and Mexico. Among offenders sentenced for marijuana possession in FY2013, the USSC reports that over 94% of those arrested at the border were not U.S. citizens. To the extent those individuals were not lawfully present in the country, they would not benefit from the pardon. Fourth, the pardon applies only to offenses committed before the proclamation. The Supreme Court has explained that the President may issue a pardon “at any time after [an offense’s] commission, either before legal proceedings are taken, or during their pendency, or after conviction and judgment.” While DOJ is currently not prioritizing prosecuting low-level marijuana offenses, the October 2022 pardon does not prevent prosecution of future offenses if the current Administration or a future Administration adopts a different policy. Fifth, the pardon may not remove all legal consequences of marijuana possession, because it does not expunge convictions. Moreover, some collateral consequences of marijuana-related activities do not depend on a person being charged with or convicted of a CSA violation. Finally, and most fundamentally, the pardon does not change the status of marijuana under federal law. The President lacks the power to make such a change unilaterally. In announcing the grant of clemency, President Biden directed the Attorney General to review the classification of marijuana under the CSA, which is one way the federal government could change the status of the substance consistently with relevant separation-of-powers principles and the CSA’s procedural requirements. Any agency action in response to that directive would likely occur through notice-and-comment rulemaking, subject to judicial review and applicable international treaty obligations. Notwithstanding the foregoing limitations, some commentators have described the October 2022 pardon as a significant development in national marijuana policy that may restore some civic rights to those who benefit from it. Some have expressed concerns that the pardon might benefit offenders who committed more serious offenses but pleaded guilty to simple possession or that relaxing controls on marijuana may generally lead to an increase in crime. Others advocate for further pardons, expungements, and legal reforms to decriminalize marijuana.
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Answer the question using only the given context block. Do not use any outside resources or prior knowledge. Format your answer in a paragraph with no more than 150 words. If you cannot answer using the context block alone, respond with "I'm sorry. I cannot find the answer in the context source." What limits the scope of Biden's pardon for Marijuana Possession? Federal Clemency for Marijuana Possession On October 6, 2022, President Biden issued a proclamation granting “a full, complete, and unconditional pardon” to “all current United States citizens and lawful permanent residents” who had committed or been convicted of simple possession of marijuana under the CSA or a related provision of the D.C. Code. President Biden’s invocation of the clemency power means that persons who committed simple possession of marijuana before the date of the proclamation may not be prosecuted or punished for the offense under the relevant provisions of the CSA or the D.C. Code. (Although the District of Columbia has its own criminal code, its criminal justice system has some overlap with the federal system and is subject to the President’s clemency power.) Several factors limit the scope of the pardon. First, it applies only to violations of federal and D.C. law and does not affect other state law marijuana offenses. In announcing the pardon, President Biden also encouraged state governors to take similar steps but, under the United States’ federalist system of government, the President has no direct power to change state law or compel the states to adopt federal policies. While some governors have taken similar steps or expressed willingness to do so, in some states, governors cannot independently grant clemency. Second, the pardon applies only to simple possession of marijuana, not to other marijuana-related CSA offenses such as manufacture, distribution, or possession with intent to distribute or to other federal crimes. Federal prosecutions of simple possession of marijuana are relatively uncommon. The U.S. Sentencing Commission (USSC) reports that about 7,700 people subject to the pardon were convicted of only simple possession since FY1992, none of whom are currently in federal custody. (Additional individuals not subject to the pardon were convicted during that period.) In FY2021, 117 people subject to the pardon were convicted of only simple possession. A smaller number of people were convicted of possessing marijuana and possessing other illicit drugs or committing other crimes. Those people would remain liable for the other offenses. Shortly after the pardon was announced, the USSC issued policy priorities including “consideration of possible amendments to the [Sentencing] Guidelines Manual relating to criminal history to address … the impact of simple possession of marihuana offenses.” Third, the pardon by its terms “does not apply to individuals who were non-citizens not lawfully present in the United States at the time of their offense.” According to a 2016 USSC report, the vast majority of federal marijuana possession arrests occur at the border between the United States and Mexico. Among offenders sentenced for marijuana possession in FY2013, the USSC reports that over 94% of those arrested at the border were not U.S. citizens. To the extent those individuals were not lawfully present in the country, they would not benefit from the pardon. Fourth, the pardon applies only to offenses committed before the proclamation. The Supreme Court has explained that the President may issue a pardon “at any time after [an offense’s] commission, either before legal proceedings are taken, or during their pendency, or after conviction and judgment.” While DOJ is currently not prioritizing prosecuting low-level marijuana offenses, the October 2022 pardon does not prevent prosecution of future offenses if the current Administration or a future Administration adopts a different policy. Fifth, the pardon may not remove all legal consequences of marijuana possession, because it does not expunge convictions. Moreover, some collateral consequences of marijuana-related activities do not depend on a person being charged with or convicted of a CSA violation. Finally, and most fundamentally, the pardon does not change the status of marijuana under federal law. The President lacks the power to make such a change unilaterally. In announcing the grant of clemency, President Biden directed the Attorney General to review the classification of marijuana under the CSA, which is one way the federal government could change the status of the substance consistently with relevant separation-of-powers principles and the CSA’s procedural requirements. Any agency action in response to that directive would likely occur through notice-and-comment rulemaking, subject to judicial review and applicable international treaty obligations. Notwithstanding the foregoing limitations, some commentators have described the October 2022 pardon as a significant development in national marijuana policy that may restore some civic rights to those who benefit from it. Some have expressed concerns that the pardon might benefit offenders who committed more serious offenses but pleaded guilty to simple possession or that relaxing controls on marijuana may generally lead to an increase in crime. Others advocate for further pardons, expungements, and legal reforms to decriminalize marijuana.
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Answer the question using only the given context block. Do not use any outside resources or prior knowledge. Format your answer in a paragraph with no more than 150 words. If you cannot answer using the context block alone, respond with "I'm sorry. I cannot find the answer in the context source."
EVIDENCE:
Federal Clemency for Marijuana Possession On October 6, 2022, President Biden issued a proclamation granting “a full, complete, and unconditional pardon” to “all current United States citizens and lawful permanent residents” who had committed or been convicted of simple possession of marijuana under the CSA or a related provision of the D.C. Code. President Biden’s invocation of the clemency power means that persons who committed simple possession of marijuana before the date of the proclamation may not be prosecuted or punished for the offense under the relevant provisions of the CSA or the D.C. Code. (Although the District of Columbia has its own criminal code, its criminal justice system has some overlap with the federal system and is subject to the President’s clemency power.) Several factors limit the scope of the pardon. First, it applies only to violations of federal and D.C. law and does not affect other state law marijuana offenses. In announcing the pardon, President Biden also encouraged state governors to take similar steps but, under the United States’ federalist system of government, the President has no direct power to change state law or compel the states to adopt federal policies. While some governors have taken similar steps or expressed willingness to do so, in some states, governors cannot independently grant clemency. Second, the pardon applies only to simple possession of marijuana, not to other marijuana-related CSA offenses such as manufacture, distribution, or possession with intent to distribute or to other federal crimes. Federal prosecutions of simple possession of marijuana are relatively uncommon. The U.S. Sentencing Commission (USSC) reports that about 7,700 people subject to the pardon were convicted of only simple possession since FY1992, none of whom are currently in federal custody. (Additional individuals not subject to the pardon were convicted during that period.) In FY2021, 117 people subject to the pardon were convicted of only simple possession. A smaller number of people were convicted of possessing marijuana and possessing other illicit drugs or committing other crimes. Those people would remain liable for the other offenses. Shortly after the pardon was announced, the USSC issued policy priorities including “consideration of possible amendments to the [Sentencing] Guidelines Manual relating to criminal history to address … the impact of simple possession of marihuana offenses.” Third, the pardon by its terms “does not apply to individuals who were non-citizens not lawfully present in the United States at the time of their offense.” According to a 2016 USSC report, the vast majority of federal marijuana possession arrests occur at the border between the United States and Mexico. Among offenders sentenced for marijuana possession in FY2013, the USSC reports that over 94% of those arrested at the border were not U.S. citizens. To the extent those individuals were not lawfully present in the country, they would not benefit from the pardon. Fourth, the pardon applies only to offenses committed before the proclamation. The Supreme Court has explained that the President may issue a pardon “at any time after [an offense’s] commission, either before legal proceedings are taken, or during their pendency, or after conviction and judgment.” While DOJ is currently not prioritizing prosecuting low-level marijuana offenses, the October 2022 pardon does not prevent prosecution of future offenses if the current Administration or a future Administration adopts a different policy. Fifth, the pardon may not remove all legal consequences of marijuana possession, because it does not expunge convictions. Moreover, some collateral consequences of marijuana-related activities do not depend on a person being charged with or convicted of a CSA violation. Finally, and most fundamentally, the pardon does not change the status of marijuana under federal law. The President lacks the power to make such a change unilaterally. In announcing the grant of clemency, President Biden directed the Attorney General to review the classification of marijuana under the CSA, which is one way the federal government could change the status of the substance consistently with relevant separation-of-powers principles and the CSA’s procedural requirements. Any agency action in response to that directive would likely occur through notice-and-comment rulemaking, subject to judicial review and applicable international treaty obligations. Notwithstanding the foregoing limitations, some commentators have described the October 2022 pardon as a significant development in national marijuana policy that may restore some civic rights to those who benefit from it. Some have expressed concerns that the pardon might benefit offenders who committed more serious offenses but pleaded guilty to simple possession or that relaxing controls on marijuana may generally lead to an increase in crime. Others advocate for further pardons, expungements, and legal reforms to decriminalize marijuana.
USER:
What limits the scope of Biden's pardon for marijuana possession?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 52 | 10 | 761 | null | 468 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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I was reading this article about Coca-cola's earnings in Q4 2022, but I need a summary. Did the earnings per share performance have an impact on the data mentioned regarding cash flow? Please explain why or why not, and make it 300-350 words
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ATLANTA, Feb. 14, 2023 – The Coca-Cola Company today reported strong fourth quarter and full-year 2022 results. “While 2022 brought many challenges, we are proud of our overall results in a dynamic operating environment,” said James Quincey, Chairman and CEO of The Coca-Cola Company. “As we begin 2023, we continue to invest in our capabilities and strengthen alignment with our bottling partners to maintain flexibility. We are keeping consumers at the center of our innovation and marketing investments, while also leveraging our expertise in revenue growth management and execution. Our growth culture is leading to new approaches, more experimentation, and improved agility to drive growth and value for our stakeholders.” Highlights Quarterly / Full-Year Performance • Revenues: For the quarter, net revenues were strong, growing 7% to $10.1 billion. Organic revenues (non-GAAP) grew 15%. Organic revenue (non-GAAP) performance was strong across operating segments and included 12% growth in price/mix and 2% growth in concentrate sales. The quarter included one additional day, which resulted in a 1-point tailwind to revenue growth. The quarter also benefited from the timing of concentrate shipments. For the full year, net revenues grew 11% to $43.0 billion, and organic revenues (non-GAAP) grew 16%. This performance was driven by 11% growth in price/mix and 5% growth in concentrate sales. • Operating margin: For the quarter, operating margin, which included items impacting comparability, was 20.5% versus 17.7% in the prior year, while comparable operating margin (non-GAAP) was 22.7% versus 22.1% in the 1 prior year. For the full year, operating margin, which included items impacting comparability, was 25.4% versus 26.7% in the prior year, while comparable operating margin (non-GAAP) was 28.7% in both the current year and the prior year. For both the quarter and the full year, operating margin benefited from strong topline growth but was unfavorably impacted by the BODYARMOR acquisition, higher operating costs, an increase in marketing investments versus the prior year, currency headwinds and items impacting comparability. • Earnings per share: For the quarter, EPS declined 16% to $0.47, and comparable EPS (non-GAAP) was even at $0.45. EPS performance included the impact of a 12-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of an 11-point currency headwind. For the full year, EPS declined 3% to $2.19, and comparable EPS (non-GAAP) grew 7% to $2.48. EPS performance included the impact of an 11-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of a 10-point currency headwind. • Market share: For both the quarter and the full year, the company gained value share in total nonalcoholic readyto-drink (“NARTD”) beverages, which included share gains in both at-home and away-from-home channels. • Cash flow: Cash flow from operations was $11.0 billion for the full year, a decline of $1.6 billion versus the prior year, as strong business performance was more than offset by the deliberate buildup of inventory in the face of a volatile commodity environment, cycling working capital benefits from the prior year, and higher tax payments and annual incentive payments in 2022. Free cash flow (non-GAAP) was $9.5 billion, a decline of $1.7 billion versus the prior year. Company Updates • Evolving company leadership to fuel growth: The company continues to focus on having the right leaders and organizational structure to deliver on its growth strategy, while also developing talent for the future. Through recent leadership appointments, the company continued to optimize its organizational design, connecting functions endto-end while identifying key opportunities to drive meaningful growth over the long term. During the quarter, John Murphy began an expanded role as President and Chief Financial Officer, and added oversight of Global Ventures, Bottling Investments, Platform Services, customer and commercial leadership, and online-to-offline digital transformation. The company also named Henrique Braun to the newly created role of President, International Development to oversee seven of the company’s nine operating units. Braun will steward growth of the consumer base across developing and emerging markets as well as developed markets. Braun will partner with Nikos Koumettis, President of the Europe operating unit, and Jennifer Mann, President of the North America operating unit, on global operational strategy in order to scale best practices and help ensure the company captures growth opportunities across all of its markets.
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[question] I was reading this article about Coca-cola's earnings in Q4 2022, but I need a summary. Did the earnings per share performance have an impact on the data mentioned regarding cash flow? Please explain why or why not, and make it 300-350 words ===================== [text] ATLANTA, Feb. 14, 2023 – The Coca-Cola Company today reported strong fourth quarter and full-year 2022 results. “While 2022 brought many challenges, we are proud of our overall results in a dynamic operating environment,” said James Quincey, Chairman and CEO of The Coca-Cola Company. “As we begin 2023, we continue to invest in our capabilities and strengthen alignment with our bottling partners to maintain flexibility. We are keeping consumers at the center of our innovation and marketing investments, while also leveraging our expertise in revenue growth management and execution. Our growth culture is leading to new approaches, more experimentation, and improved agility to drive growth and value for our stakeholders.” Highlights Quarterly / Full-Year Performance • Revenues: For the quarter, net revenues were strong, growing 7% to $10.1 billion. Organic revenues (non-GAAP) grew 15%. Organic revenue (non-GAAP) performance was strong across operating segments and included 12% growth in price/mix and 2% growth in concentrate sales. The quarter included one additional day, which resulted in a 1-point tailwind to revenue growth. The quarter also benefited from the timing of concentrate shipments. For the full year, net revenues grew 11% to $43.0 billion, and organic revenues (non-GAAP) grew 16%. This performance was driven by 11% growth in price/mix and 5% growth in concentrate sales. • Operating margin: For the quarter, operating margin, which included items impacting comparability, was 20.5% versus 17.7% in the prior year, while comparable operating margin (non-GAAP) was 22.7% versus 22.1% in the 1 prior year. For the full year, operating margin, which included items impacting comparability, was 25.4% versus 26.7% in the prior year, while comparable operating margin (non-GAAP) was 28.7% in both the current year and the prior year. For both the quarter and the full year, operating margin benefited from strong topline growth but was unfavorably impacted by the BODYARMOR acquisition, higher operating costs, an increase in marketing investments versus the prior year, currency headwinds and items impacting comparability. • Earnings per share: For the quarter, EPS declined 16% to $0.47, and comparable EPS (non-GAAP) was even at $0.45. EPS performance included the impact of a 12-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of an 11-point currency headwind. For the full year, EPS declined 3% to $2.19, and comparable EPS (non-GAAP) grew 7% to $2.48. EPS performance included the impact of an 11-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of a 10-point currency headwind. • Market share: For both the quarter and the full year, the company gained value share in total nonalcoholic readyto-drink (“NARTD”) beverages, which included share gains in both at-home and away-from-home channels. • Cash flow: Cash flow from operations was $11.0 billion for the full year, a decline of $1.6 billion versus the prior year, as strong business performance was more than offset by the deliberate buildup of inventory in the face of a volatile commodity environment, cycling working capital benefits from the prior year, and higher tax payments and annual incentive payments in 2022. Free cash flow (non-GAAP) was $9.5 billion, a decline of $1.7 billion versus the prior year. Company Updates • Evolving company leadership to fuel growth: The company continues to focus on having the right leaders and organizational structure to deliver on its growth strategy, while also developing talent for the future. Through recent leadership appointments, the company continued to optimize its organizational design, connecting functions endto-end while identifying key opportunities to drive meaningful growth over the long term. During the quarter, John Murphy began an expanded role as President and Chief Financial Officer, and added oversight of Global Ventures, Bottling Investments, Platform Services, customer and commercial leadership, and online-to-offline digital transformation. The company also named Henrique Braun to the newly created role of President, International Development to oversee seven of the company’s nine operating units. Braun will steward growth of the consumer base across developing and emerging markets as well as developed markets. Braun will partner with Nikos Koumettis, President of the Europe operating unit, and Jennifer Mann, President of the North America operating unit, on global operational strategy in order to scale best practices and help ensure the company captures growth opportunities across all of its markets. https://d1io3yog0oux5.cloudfront.net/_e75f7be04b2b22ee66e5d86d26087f1e/cocacolacompany/db/734/7960/earnings_release/Coca-Cola+fourth+quarter+and+full+year+2022+full+earnings+release-2.14.23+FINAL.pdf ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
ATLANTA, Feb. 14, 2023 – The Coca-Cola Company today reported strong fourth quarter and full-year 2022 results. “While 2022 brought many challenges, we are proud of our overall results in a dynamic operating environment,” said James Quincey, Chairman and CEO of The Coca-Cola Company. “As we begin 2023, we continue to invest in our capabilities and strengthen alignment with our bottling partners to maintain flexibility. We are keeping consumers at the center of our innovation and marketing investments, while also leveraging our expertise in revenue growth management and execution. Our growth culture is leading to new approaches, more experimentation, and improved agility to drive growth and value for our stakeholders.” Highlights Quarterly / Full-Year Performance • Revenues: For the quarter, net revenues were strong, growing 7% to $10.1 billion. Organic revenues (non-GAAP) grew 15%. Organic revenue (non-GAAP) performance was strong across operating segments and included 12% growth in price/mix and 2% growth in concentrate sales. The quarter included one additional day, which resulted in a 1-point tailwind to revenue growth. The quarter also benefited from the timing of concentrate shipments. For the full year, net revenues grew 11% to $43.0 billion, and organic revenues (non-GAAP) grew 16%. This performance was driven by 11% growth in price/mix and 5% growth in concentrate sales. • Operating margin: For the quarter, operating margin, which included items impacting comparability, was 20.5% versus 17.7% in the prior year, while comparable operating margin (non-GAAP) was 22.7% versus 22.1% in the 1 prior year. For the full year, operating margin, which included items impacting comparability, was 25.4% versus 26.7% in the prior year, while comparable operating margin (non-GAAP) was 28.7% in both the current year and the prior year. For both the quarter and the full year, operating margin benefited from strong topline growth but was unfavorably impacted by the BODYARMOR acquisition, higher operating costs, an increase in marketing investments versus the prior year, currency headwinds and items impacting comparability. • Earnings per share: For the quarter, EPS declined 16% to $0.47, and comparable EPS (non-GAAP) was even at $0.45. EPS performance included the impact of a 12-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of an 11-point currency headwind. For the full year, EPS declined 3% to $2.19, and comparable EPS (non-GAAP) grew 7% to $2.48. EPS performance included the impact of an 11-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of a 10-point currency headwind. • Market share: For both the quarter and the full year, the company gained value share in total nonalcoholic readyto-drink (“NARTD”) beverages, which included share gains in both at-home and away-from-home channels. • Cash flow: Cash flow from operations was $11.0 billion for the full year, a decline of $1.6 billion versus the prior year, as strong business performance was more than offset by the deliberate buildup of inventory in the face of a volatile commodity environment, cycling working capital benefits from the prior year, and higher tax payments and annual incentive payments in 2022. Free cash flow (non-GAAP) was $9.5 billion, a decline of $1.7 billion versus the prior year. Company Updates • Evolving company leadership to fuel growth: The company continues to focus on having the right leaders and organizational structure to deliver on its growth strategy, while also developing talent for the future. Through recent leadership appointments, the company continued to optimize its organizational design, connecting functions endto-end while identifying key opportunities to drive meaningful growth over the long term. During the quarter, John Murphy began an expanded role as President and Chief Financial Officer, and added oversight of Global Ventures, Bottling Investments, Platform Services, customer and commercial leadership, and online-to-offline digital transformation. The company also named Henrique Braun to the newly created role of President, International Development to oversee seven of the company’s nine operating units. Braun will steward growth of the consumer base across developing and emerging markets as well as developed markets. Braun will partner with Nikos Koumettis, President of the Europe operating unit, and Jennifer Mann, President of the North America operating unit, on global operational strategy in order to scale best practices and help ensure the company captures growth opportunities across all of its markets.
USER:
I was reading this article about Coca-cola's earnings in Q4 2022, but I need a summary. Did the earnings per share performance have an impact on the data mentioned regarding cash flow? Please explain why or why not, and make it 300-350 words
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 43 | 699 | null | 72 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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What are the steps to apoptosis? What are the differentiating factors of necrosis and apoptosis? What are the different ways a cell can be affected by necrosis?
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The stages of cell death differ depending on how a cell dies. When it comes to cell death, there are two main types to consider: Necrosis Vs. Apoptosis. Each of these involves a distinct process and has a distinct impact on the rest of the body.It holds utmost significance for researchers and they must choose the best Cell Separation technologies to get high-quality results. What is Cell Apoptosis? Apoptosis, or programmed cell death, is a normal growth and development mechanism within an organism. Because the cell participates in its own death, this process is also known as “cellular suicide.” Apoptosis contributes to the balance of cell multiplication. Uncontrolled cell growth will result in tumors and other problems if cells continue to reproduce without apoptosis. What Causes Apoptosis? Apoptosis is also known as programmed cell death because it is usually triggered by self-generated signals within a cell. It is a normal part of the cell cycle that begins with mitosis in cell reproduction. Caspases, enzymes found in all cells that cleave specific proteins to initiate cell death, mediate this process. Apoptosis Steps Apoptosis occurs in a gentle and controlled manner that has no negative impact on surrounding cells. A cell will expel moisture in order to dry out and condense until fragmentation occurs. Because the cell does not release into the extracellular environment, there are no morphological changes. Apoptotic bodies are small vesicles that form to transport the contents of the cell elsewhere. This enables cells to die gently and without causing inflammation. Apoptosis is signaled by chromatin condensation in a cell’s nucleus. This allows scientists to determine whether a cell is dying naturally or unnaturally. What is Cell Necrosis? Necrosis is a type of cell death that occurs when cells are exposed to extreme conditions. Cells may sustain damage to their internal environment when not under normal conditions. Tissues may deteriorate quickly and harshly. As a result, necrosis is commonly defined as unintentional cell death. Causes of Necrotic Cell Death External factors influencing the physiology of cells in the body cause necrosis. The following are some examples of necrotic cell death causes: Bacterial infection – Bacteria are microscopic organisms that can cause infections in the body if they enter through an airway or an open wound. They may be responsible for a variety of illnesses linked to unplanned cell death. Fungal infection – A fungus infection, also known as mycosis, occurs when any fungus infiltrates human tissues. This could result in skin or internal system diseases, as well as unprogrammed cell death. Pancreatitis – Pancreatitis is an inflammation of the pancreas, a gland in the body that helps regulate hormones and digestion. Protein denaturation – Protein denaturation occurs when weak bonds in proteins break down, causing the cells’ ability to function properly to suffer. Apoptosis Vs. Necrosis While both necrosis and apoptosis are mechanisms involved in multicellular organism cell death, they can be distinguished in a variety of ways. Apoptosis is regarded as a naturally occurring process, whereas necrosis is regarded as a pathological process. Pathological processes are often unregulated and are caused by toxins, infections, or traumas. Apoptosis is controlled and timely, making it predictable and beneficial to the host. Read Also: T Cell Isolation:A Comprehensive Guide to the Key Components The distinction between apoptosis and necrosis is also visible in the following factors: Process – Apoptosis is characterized by the shrinking of the cytoplasm, which results in the condensation of the nucleus. Necrosis occurs when the cytoplasm and mitochondria swell, resulting in cell lysis or a rupture in the cell membrane. Membrane Integrity – Blebbing is a defining feature of apoptosis. Blebbing occurs when a cell’s cytoskeleton degrades and the membrane bulges outward. Apoptotic blebs can form when cytoplasmic capsules detach from dying cells. This has no effect on the membrane’s integrity. The integrity of the membrane is loosened and thus significantly reduced, if not completely lost, during necrosis. Organelle Behavior – Organelles can continue to function even after a cell has died due to apoptosis. Organelles swell and disintegrate during necrotic cell death. After necrosis, organelles are no longer functional. Scope of Affected Cells – Apoptosis is a localized process that only destroys individual or single cells. Necrosis can spread to affect adjacent cell groups, causing damage beyond the initial site. Bodily Influence – Apoptosis is involved in controlling cell numbers and is frequently beneficial. Apoptosis, on the other hand, can cause diseases if it becomes abnormal in either direction. Necrosis, on the other hand, is always harmful and, if left untreated, can be fatal. In essence, apoptosis is planned cell death in which the cell actively destroys itself in order to maintain body functionality. Necrosis is an unintentional or unplanned cell death caused by the cell’s external environment, which impedes or interferes with body functions or health. Dangers of Cell Death in a Sample Cell enrichment assays can be hampered by both Necrosis & Apoptosis. The goal of studying a cell population is to collect as many healthy target cells as possible. Damaged cells do not behave the same as healthy cells and thus produce insufficient results. When collecting and storing cell samples, the longer a cell is kept outside of its preferred environment, the more likely it will die from necrosis. Cells can swell and die as a result of external factors. Dead cells can clump and cause more cell death in the surrounding population when using traditional cell separation methods such as magnetic-based cell sorting. It is critical to follow protocols, use gentle cell separation methods, and use additional products for increased downstream accuracy to maintain cell health and purity during cell separation assays. Harnessing Pluriselect’s Innovative Technology: Plurispin and PluriBead The first method for reducing cell death is to use a gentler isolation method. Traditional separation technologies, such as magnetic bead-based sorting, can be harsh on cells and result in less-than-desirable outcomes. Let’s see what Plurispin and PluriBead can do for us. Plurispin The pluriSpin system is a new negative cell isolation technology that can be used to isolate cells directly from whole blood, buffy coat, or cord blood. This new method isolates viable, untouched, and highly purified cells in a single step without the use of magnets or a column. As a result, there is less chance of activating or damaging the cells of interest. PluriBead PluriBead is a unique cell separation technology that does not rely on magnetic components. The steps are straightforward: Your pluriBeads (containing bound target cells) are sieved through a strainer; the pluriBeads containing your target cells remain on top, while the unwanted cells pass through. You have your target cells ready after detaching. Ready to get started? Stop wasting your valuable samples on inefficient processes and see the difference for yourself. Pluriselect’s innovative technology provides an incredibly fast, simple workflow that allows you to confidently move to downstream processing.
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[question] What are the steps to apoptosis? What are the differentiating factors of necrosis and apoptosis? What are the different ways a cell can be affected by necrosis? ===================== [text] The stages of cell death differ depending on how a cell dies. When it comes to cell death, there are two main types to consider: Necrosis Vs. Apoptosis. Each of these involves a distinct process and has a distinct impact on the rest of the body.It holds utmost significance for researchers and they must choose the best Cell Separation technologies to get high-quality results. What is Cell Apoptosis? Apoptosis, or programmed cell death, is a normal growth and development mechanism within an organism. Because the cell participates in its own death, this process is also known as “cellular suicide.” Apoptosis contributes to the balance of cell multiplication. Uncontrolled cell growth will result in tumors and other problems if cells continue to reproduce without apoptosis. What Causes Apoptosis? Apoptosis is also known as programmed cell death because it is usually triggered by self-generated signals within a cell. It is a normal part of the cell cycle that begins with mitosis in cell reproduction. Caspases, enzymes found in all cells that cleave specific proteins to initiate cell death, mediate this process. Apoptosis Steps Apoptosis occurs in a gentle and controlled manner that has no negative impact on surrounding cells. A cell will expel moisture in order to dry out and condense until fragmentation occurs. Because the cell does not release into the extracellular environment, there are no morphological changes. Apoptotic bodies are small vesicles that form to transport the contents of the cell elsewhere. This enables cells to die gently and without causing inflammation. Apoptosis is signaled by chromatin condensation in a cell’s nucleus. This allows scientists to determine whether a cell is dying naturally or unnaturally. What is Cell Necrosis? Necrosis is a type of cell death that occurs when cells are exposed to extreme conditions. Cells may sustain damage to their internal environment when not under normal conditions. Tissues may deteriorate quickly and harshly. As a result, necrosis is commonly defined as unintentional cell death. Causes of Necrotic Cell Death External factors influencing the physiology of cells in the body cause necrosis. The following are some examples of necrotic cell death causes: Bacterial infection – Bacteria are microscopic organisms that can cause infections in the body if they enter through an airway or an open wound. They may be responsible for a variety of illnesses linked to unplanned cell death. Fungal infection – A fungus infection, also known as mycosis, occurs when any fungus infiltrates human tissues. This could result in skin or internal system diseases, as well as unprogrammed cell death. Pancreatitis – Pancreatitis is an inflammation of the pancreas, a gland in the body that helps regulate hormones and digestion. Protein denaturation – Protein denaturation occurs when weak bonds in proteins break down, causing the cells’ ability to function properly to suffer. Apoptosis Vs. Necrosis While both necrosis and apoptosis are mechanisms involved in multicellular organism cell death, they can be distinguished in a variety of ways. Apoptosis is regarded as a naturally occurring process, whereas necrosis is regarded as a pathological process. Pathological processes are often unregulated and are caused by toxins, infections, or traumas. Apoptosis is controlled and timely, making it predictable and beneficial to the host. Read Also: T Cell Isolation:A Comprehensive Guide to the Key Components The distinction between apoptosis and necrosis is also visible in the following factors: Process – Apoptosis is characterized by the shrinking of the cytoplasm, which results in the condensation of the nucleus. Necrosis occurs when the cytoplasm and mitochondria swell, resulting in cell lysis or a rupture in the cell membrane. Membrane Integrity – Blebbing is a defining feature of apoptosis. Blebbing occurs when a cell’s cytoskeleton degrades and the membrane bulges outward. Apoptotic blebs can form when cytoplasmic capsules detach from dying cells. This has no effect on the membrane’s integrity. The integrity of the membrane is loosened and thus significantly reduced, if not completely lost, during necrosis. Organelle Behavior – Organelles can continue to function even after a cell has died due to apoptosis. Organelles swell and disintegrate during necrotic cell death. After necrosis, organelles are no longer functional. Scope of Affected Cells – Apoptosis is a localized process that only destroys individual or single cells. Necrosis can spread to affect adjacent cell groups, causing damage beyond the initial site. Bodily Influence – Apoptosis is involved in controlling cell numbers and is frequently beneficial. Apoptosis, on the other hand, can cause diseases if it becomes abnormal in either direction. Necrosis, on the other hand, is always harmful and, if left untreated, can be fatal. In essence, apoptosis is planned cell death in which the cell actively destroys itself in order to maintain body functionality. Necrosis is an unintentional or unplanned cell death caused by the cell’s external environment, which impedes or interferes with body functions or health. Dangers of Cell Death in a Sample Cell enrichment assays can be hampered by both Necrosis & Apoptosis. The goal of studying a cell population is to collect as many healthy target cells as possible. Damaged cells do not behave the same as healthy cells and thus produce insufficient results. When collecting and storing cell samples, the longer a cell is kept outside of its preferred environment, the more likely it will die from necrosis. Cells can swell and die as a result of external factors. Dead cells can clump and cause more cell death in the surrounding population when using traditional cell separation methods such as magnetic-based cell sorting. It is critical to follow protocols, use gentle cell separation methods, and use additional products for increased downstream accuracy to maintain cell health and purity during cell separation assays. Harnessing Pluriselect’s Innovative Technology: Plurispin and PluriBead The first method for reducing cell death is to use a gentler isolation method. Traditional separation technologies, such as magnetic bead-based sorting, can be harsh on cells and result in less-than-desirable outcomes. Let’s see what Plurispin and PluriBead can do for us. Plurispin The pluriSpin system is a new negative cell isolation technology that can be used to isolate cells directly from whole blood, buffy coat, or cord blood. This new method isolates viable, untouched, and highly purified cells in a single step without the use of magnets or a column. As a result, there is less chance of activating or damaging the cells of interest. PluriBead PluriBead is a unique cell separation technology that does not rely on magnetic components. The steps are straightforward: Your pluriBeads (containing bound target cells) are sieved through a strainer; the pluriBeads containing your target cells remain on top, while the unwanted cells pass through. You have your target cells ready after detaching. Ready to get started? Stop wasting your valuable samples on inefficient processes and see the difference for yourself. Pluriselect’s innovative technology provides an incredibly fast, simple workflow that allows you to confidently move to downstream processing. https://uberstrainer.com/necrosis-vs-apoptosis-necrotic-cell-death-processes-apoptosis-steps/?srsltid=AfmBOorXdBv0i9nIoJj0a0EJSaMNsEfUera9WQT93AqxIR9fd5FupZMu ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
The stages of cell death differ depending on how a cell dies. When it comes to cell death, there are two main types to consider: Necrosis Vs. Apoptosis. Each of these involves a distinct process and has a distinct impact on the rest of the body.It holds utmost significance for researchers and they must choose the best Cell Separation technologies to get high-quality results. What is Cell Apoptosis? Apoptosis, or programmed cell death, is a normal growth and development mechanism within an organism. Because the cell participates in its own death, this process is also known as “cellular suicide.” Apoptosis contributes to the balance of cell multiplication. Uncontrolled cell growth will result in tumors and other problems if cells continue to reproduce without apoptosis. What Causes Apoptosis? Apoptosis is also known as programmed cell death because it is usually triggered by self-generated signals within a cell. It is a normal part of the cell cycle that begins with mitosis in cell reproduction. Caspases, enzymes found in all cells that cleave specific proteins to initiate cell death, mediate this process. Apoptosis Steps Apoptosis occurs in a gentle and controlled manner that has no negative impact on surrounding cells. A cell will expel moisture in order to dry out and condense until fragmentation occurs. Because the cell does not release into the extracellular environment, there are no morphological changes. Apoptotic bodies are small vesicles that form to transport the contents of the cell elsewhere. This enables cells to die gently and without causing inflammation. Apoptosis is signaled by chromatin condensation in a cell’s nucleus. This allows scientists to determine whether a cell is dying naturally or unnaturally. What is Cell Necrosis? Necrosis is a type of cell death that occurs when cells are exposed to extreme conditions. Cells may sustain damage to their internal environment when not under normal conditions. Tissues may deteriorate quickly and harshly. As a result, necrosis is commonly defined as unintentional cell death. Causes of Necrotic Cell Death External factors influencing the physiology of cells in the body cause necrosis. The following are some examples of necrotic cell death causes: Bacterial infection – Bacteria are microscopic organisms that can cause infections in the body if they enter through an airway or an open wound. They may be responsible for a variety of illnesses linked to unplanned cell death. Fungal infection – A fungus infection, also known as mycosis, occurs when any fungus infiltrates human tissues. This could result in skin or internal system diseases, as well as unprogrammed cell death. Pancreatitis – Pancreatitis is an inflammation of the pancreas, a gland in the body that helps regulate hormones and digestion. Protein denaturation – Protein denaturation occurs when weak bonds in proteins break down, causing the cells’ ability to function properly to suffer. Apoptosis Vs. Necrosis While both necrosis and apoptosis are mechanisms involved in multicellular organism cell death, they can be distinguished in a variety of ways. Apoptosis is regarded as a naturally occurring process, whereas necrosis is regarded as a pathological process. Pathological processes are often unregulated and are caused by toxins, infections, or traumas. Apoptosis is controlled and timely, making it predictable and beneficial to the host. Read Also: T Cell Isolation:A Comprehensive Guide to the Key Components The distinction between apoptosis and necrosis is also visible in the following factors: Process – Apoptosis is characterized by the shrinking of the cytoplasm, which results in the condensation of the nucleus. Necrosis occurs when the cytoplasm and mitochondria swell, resulting in cell lysis or a rupture in the cell membrane. Membrane Integrity – Blebbing is a defining feature of apoptosis. Blebbing occurs when a cell’s cytoskeleton degrades and the membrane bulges outward. Apoptotic blebs can form when cytoplasmic capsules detach from dying cells. This has no effect on the membrane’s integrity. The integrity of the membrane is loosened and thus significantly reduced, if not completely lost, during necrosis. Organelle Behavior – Organelles can continue to function even after a cell has died due to apoptosis. Organelles swell and disintegrate during necrotic cell death. After necrosis, organelles are no longer functional. Scope of Affected Cells – Apoptosis is a localized process that only destroys individual or single cells. Necrosis can spread to affect adjacent cell groups, causing damage beyond the initial site. Bodily Influence – Apoptosis is involved in controlling cell numbers and is frequently beneficial. Apoptosis, on the other hand, can cause diseases if it becomes abnormal in either direction. Necrosis, on the other hand, is always harmful and, if left untreated, can be fatal. In essence, apoptosis is planned cell death in which the cell actively destroys itself in order to maintain body functionality. Necrosis is an unintentional or unplanned cell death caused by the cell’s external environment, which impedes or interferes with body functions or health. Dangers of Cell Death in a Sample Cell enrichment assays can be hampered by both Necrosis & Apoptosis. The goal of studying a cell population is to collect as many healthy target cells as possible. Damaged cells do not behave the same as healthy cells and thus produce insufficient results. When collecting and storing cell samples, the longer a cell is kept outside of its preferred environment, the more likely it will die from necrosis. Cells can swell and die as a result of external factors. Dead cells can clump and cause more cell death in the surrounding population when using traditional cell separation methods such as magnetic-based cell sorting. It is critical to follow protocols, use gentle cell separation methods, and use additional products for increased downstream accuracy to maintain cell health and purity during cell separation assays. Harnessing Pluriselect’s Innovative Technology: Plurispin and PluriBead The first method for reducing cell death is to use a gentler isolation method. Traditional separation technologies, such as magnetic bead-based sorting, can be harsh on cells and result in less-than-desirable outcomes. Let’s see what Plurispin and PluriBead can do for us. Plurispin The pluriSpin system is a new negative cell isolation technology that can be used to isolate cells directly from whole blood, buffy coat, or cord blood. This new method isolates viable, untouched, and highly purified cells in a single step without the use of magnets or a column. As a result, there is less chance of activating or damaging the cells of interest. PluriBead PluriBead is a unique cell separation technology that does not rely on magnetic components. The steps are straightforward: Your pluriBeads (containing bound target cells) are sieved through a strainer; the pluriBeads containing your target cells remain on top, while the unwanted cells pass through. You have your target cells ready after detaching. Ready to get started? Stop wasting your valuable samples on inefficient processes and see the difference for yourself. Pluriselect’s innovative technology provides an incredibly fast, simple workflow that allows you to confidently move to downstream processing.
USER:
What are the steps to apoptosis? What are the differentiating factors of necrosis and apoptosis? What are the different ways a cell can be affected by necrosis?
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I know that violent video games can potentially have negative effects on children, but are there any positive psychological effects associated with video games?
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Parents often ask about the effects of violent video games on their children and teenagers. In most cases, they note that their “common sense” instinct is that too much exposure to violent video games must have some sort of negative effect on their children, but that they have read in the media that “the jury is still out” on violent media effects or that there is no convincing evidence that violent video game playing is harmful. Confusion around this conflict will often prompt them then to ask: “what does the scientific evidence really say?” In this chapter we show that the common sense view is backed up by a substantial body of recent scientific findings. Helpful and pro-social video game content has great potential for enhancing the lives of children and adolescents, but exposure to anti-social and violent video game content increases the likelihood of a range of negative outcomes, with greater exposure increasing the risk. Video games have been around for nearly 50 years. Kirsch (2010) notes the first as being Spacewar (released in 1962), a game in which two spaceships battle to the death in space. Although the graphics were very simple compared to modern games, the theme of battling to the death is one that has endured through the ensuing five decades. According to the most recent comprehensive poll by the Kaiser Foundation, American children aged 8–18 play an average of eight hours of video games per week, an increase of over 400 per cent from 1999 (Rideout, Foehr & Roberts, 2010). Playing is heaviest in the 11–14 age group, with boys outplaying girls more than 2.5 hours to 1. A recent study suggests that around 99 per cent of American boys play video games, along with 94 per cent of girls (Lenhart et al, 2008). It is common for US children and adolescents to play more than 20 hours per week 56Chapter in W. Warburton & D. Braunstein (Eds.) Growing Up Fast and Furious: Reviewing the Impacts of Violent and Sexualised Media on Children, (pp. 56-84). Annandale, NSW, Australia: The Federation Press. and it is not uncommon for males to play 40 hours or more per week (Bailey, West & Anderson, 2010). On average, Australian 7–18-year-olds played somewhat less than their US counterparts in 2007 (4.7 hours per week: see ACMA, 2007), but this figure could have risen substantially in recent years if Australian children have followed the steep upward trend found in the latest US studies. The types of games vary, but content analyses by Dill and colleagues (2005) show that the majority of top selling video games and children’s favourite games contain violence, and often strong violence. More recently, Call of Duty: Modern Warfare 2 grossed ~$USD 550 million in the first five days of its 2009 release, at that time more than any other entertainment product in history (movies included). Next on the list in 2009 was Grant Theft Auto IV (GTA), with ~$USD 500 million in five days. Even more recently (a year is a long time in the video game world) Call of Duty: Black Ops grossed $USD 360 million in a single day, breaking all records (Ortutay, 2010). According to Wikipedia, the massive multiplayer online game (MMOG) World of Warcraft has more than 12 million online subscribers and thus currently grosses more than $USD 180 million per month (at $15 per month per player). GTA, which is rated M17+ in the United States and involves such activities as going on murderous rampages, having sex with prostitutes and then murdering them to retrieve the money paid, has been played by 56 per cent of United States children aged 8–18 (Rideout et al, 2010). Clearly, a large number of children and adolescents are exposed regularly to video games with high levels of violence and anti-social themes. This makes it important for parents, educators and professionals who work with children to have some knowledge of their effects. Before turning to the negative effects of violent video games however, it is important to stress that video games can have many helpful benefits. Here are just a few. Helpful effects of video games Pain management Kirsch (2010) notes that various media, including video games, can be used to distract and relax children during painful medical procedures. 57 The impACT of violenT video gAmes: An overview Coordination and spatial cognition A number of studies reveal that video games which require the place- ment of objects within a screen (such as Tetris) can enhance the spatial cognition abilities of players (that is, the ability to mentally arrange and rotate objects in three dimensions). Indeed, video game playing has been linked with a wide array of visual and spatial skills, primarily through practice effects (see Green & Bavelier, 2006; Okagaki & Frensch, 1994; see also Bailey et al, 2010, for a review). In one study by Gopher, Weil and Bareket (1994), the flight performance of Israeli Air Force cadets who had been trained on the Space Fortress II video game was compared with the performance of an untrained group. The trained cadets performed better in almost all aspects of flight performance and as a result the game was incorporated into the Israeli Air Force training program. Pro-social behaviour Although this area of study is still in its infancy, there is mounting evidence that video games which model and involve participants in pro- social, helping behaviours can lead to increases in pro-social behaviour in the short and long term. Most notably, Gentile et al (2009) found that elementary school students exposed to pro-social video games were more helpful than those exposed to violent or non-social video games. In a second longitudinal study of Japanese children in grades 5, 8 and 11, exposure to pro-social video games at the start of the study was linked with increased pro-social behaviour some months later, even when the baseline pro-social tendencies of children were statistically removed. In a final study of Singaporean secondary school students, the amount of pro-social video game play experienced was correlated with helping behaviour, cooperation, sharing and empathy. A study by Greitemeyer and Osswald (2009) found that pro-social video game playing led to a short-term reduction in the tendency to see the world as hostile and an immediate reduction in anti-social thoughts. Education A considerable literature reveals video games to be a powerful teaching tool (eg, Barlett et al, 2009; Murphy et al, 2002; Swing & Anderson, 58 growing up fAsT And furious 2008). They have been used to teach algebra (Corbett et al, 2001), biol- ogy (Ybarrondo, 1984), photography (Abrams, 1986), and computer programming (Kahn, 1999), to teach children how to manage diabetes (Lieberman, 2001; 2006) and to teach specific skills using simulators (for example, by Qantas pilots, NASA and the Air Force). Gentile and Gentile (2008) describe the educational advantages of using video games as teaching tools. These include the power of video games to engage children and to “encourage children to persevere in acquiring and mastering a number of skills, to navigate through complex problems and changing environments, and to experiment with different identities until success is achieved” (p 127). Exercise There has been a recent explosion in the popularity of video games that promote physical activity and exercise (that is, “Exergames”). Games such as Wii Sports Heart Rate; Wii Fit; Wii Play; Wii FitPlus; Dance, Dance Revolution and Just Dance seem to be part of a recent trend that has seen an increase in the availability and popularity of non-violent, helpful games. Clearly, video games have considerable potential to enhance the lives of children and adolescents. Unfortunately, excessive video game playing, especially of violent video games, has the potential to impact children in a number of negative ways. Harmful effects of video games Video game addiction In his moving biography, Unplugged: My Journey into the Dark World of Video Game Addiction, Ryan Van Cleave describes the way that a violent online game, World of Warcraft, dominated his life to such an extent that he was unable to function normally and was driven to the verge of suicide. Video game addiction is now taken so seriously by psychologists and psychiatrists that it was recently considered for inclusion in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) as a diagnosable psychiatric disorder and has been lodged in its appendix to encourage further research. It is clear that many children 59 The impACT of violenT video gAmes: An overview play video games at a “pathological” level that causes damage to family, social, school or psychological functioning (see Anderson et al, 2012). For example, it has been found that 8.5 per cent of 8–18-year-old US video game players do so at pathological levels (Gentile, 2009). Similar studies have found figures of 11.9 per cent in Europe (Grusser et al, 2007), 8.7 per cent in Singapore (Choo et al, 2010), 10.3 per cent in China (Peng & Li, 2009) and 4 per cent for 12–18-year-olds in Norway (Johansson & Götestam, 2004), with a further 15.5 per cent “at risk”. As will be seen in the ensuing sections, the amount that children play video games is very important. Those who play excessively are not only at risk of a number of negative outcomes, they are also much more likely to be playing violent games (see Krahé & Möller, 2004). Attention deficits There are some studies linking the amount of time children spend play- ing video games to attention deficits, impulsivity and hyperactivity (see Bailey et al, 2010; Swing et al, 2010). For example, Gentile (2009) found that adolescents who used video games at pathological levels were nearly three times more likely to be diagnosed with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder than adolescents who played at non-pathological levels. In a landmark paper, Swing and colleagues (2010) examined the effect of video game playing on atten- tion in elementary school children. They used a longitudinal study that statistically controlled for a range of other factors that could also lead to attention problems and found that amount of time spent playing video games predicted increases in teacher assessments of attention deficits in the children 13 months later. These results suggest that the children’s level of video game playing played a causal role in their subsequent loss of attentional capacity. Anderson et al (2012) believe that on theoretical grounds some video games should have less effect on attentional problems (for exam- ple, those that require controlled thought and planning) and that those which require constant reactive behaviours from players (a common feature of many violent first person shooting games for example) may be more problematic in terms of children developing attentional difficulties. 60 growing up fAsT And furious School performance It is well established that spending longer hours playing video games is linked with poorer school performance for both children and adoles- cents (Anderson et al, 2007; Chan & Rabinowitz, 2006; Chiu et al, 2004; Cordes & Miller, 2000; Gentile, 2009; Gentile et al, 2004; Sharif & Sargent, 2006). One explanation for this is a simple displacement of time – hours spent playing video games eats into time that would normally be spent studying and reading. For example, in a study of 1491 youth between 10 and 19, gamers spent 30 per cent less time reading and 34 per cent less time doing homework (Cummings & Vandewater, 2007). It is also possible, however, that children who perform more poorly at school are also more likely to “spend more time playing games, where they may feel a sense of mastery that eludes them at school” (Anderson et al, 2012). Of course, another possibility is the that excessive gaming creates attention deficits, which in turn can lead to poorer school performance. Increased aggression Should we be concerned about children and adolescents playing violent video games? Can this lead to aggressive behaviour? Over 98 per cent of paediatricians in the United States have considered these questions and believe that excessive violent media exposure has a negative effect on childhood aggression (Gentile et al, 2004). Similarly, there is a consen- sus amongst the vast majority of violent video game researchers that too much exposure to violent video games increases the likelihood of aggressive thoughts, feelings and behaviours, leads to desensitisation to violence and also leads to decreases in pro-social behaviours and empathy (Anderson et al, 2010; Huesmann, 2010). There are, however, a small number of researchers who dispute this evidence and it seems that the views of this small minority have had a large impact on public perceptions (Anderson & Gentile, 2008; Dill, 2009). In this section of the chapter we will broadly examine the arguments for this view and then review the scientific evidence that does find violent video game effects. In this way, we hope that readers can judge the evidence for themselves. 1. The first argument against violent video game effects is that there is little evidence linking the playing of violent video games to very violent behaviours (such as school shootings). To better understand 61 The impACT of violenT video gAmes: An overview this argument it is helpful to reflect on the difference between aggres- sion and violence. In essence, violence is aggressive behaviour that has extreme harm as its goal (Anderson & Bushman, 2002). Thus, all violence is aggression but not all aggression is violence. With this in mind we make four points. (a) Ethically it is not possible to use the most powerful methods – experi- mental manipulations – to test the causal link between violent video games and violence because we cannot rightfully incite people to cause extreme harm in a laboratory. There are, however, ways to test links with aggressive behaviour, which can be examined ethi- cally in a laboratory. It is disingenuous to suggest that because there are no experimental studies that randomly assign children to years of playing violent or nonviolent video games and then measure which group commits the most violent crimes, that therefore there are no established negative or anti-social effects. This is like saying that because there are no experimental studies on humans showing that cigarette smoking causes lung cancer, smoking is not a causal risk factor. The causal links between violent video game playing and physical aggression are, in our opinion, well established. (b) Cross-sectional (correlational) studies and longitudinal studies of violent video game effects have established significant links to violent behaviour. Several longitudinal studies in particular provide strong evidence that these are causal effects. (c) Aggressive behaviour, which can include bullying, hurting other people physically, hurting other people’s property or relationships and hurting people verbally, is a very important social phenomenon in its own right. Aggression does not have to escalate into violence to be harmful and destructive. (d) No aggression researchers claim that media violence is the sole or even the most important source of violent behaviour. The most common approach, and the one taken by the authors, is the “risk factor” approach. According to this approach, people can have vari- ous risk factors for aggression or violent behaviour (see Figure 1). These might include coming from a violent home, having a violent peer group, high levels of trait aggression, exposure to violent media and a number of other factors. The more risk factors that are present for a person, especially when they are present from a young age, the more likely that person is to be aggressive or violent. Strasburger (2009, p 203) notes that: The research on media violence and its relationship to real-life aggression is clear: young people learn their attitudes about violence at a very young age, and once learned, those attitudes are difficult to change (Anderson et al, 2003; Bushman & Huesmann, 2006). Conservative estimates are that media violence may be causing 10% of real-life violence – not the leading cause by any means, but an unhealthy chunk that we could do something about if we chose to (Strasburger et al, 2009; Comstock & Strasburger, 1990). We believe that Victor Strasburger is right. Many risk factors for aggression and violence are very hard to deal with as parents, as educators, as professionals and as policy-makers. Media violence, though, is one risk factor that can be controlled and about which action can be taken from the level of the individual home through to the level of State and federal governments. This makes the research on media violence effects particularly important. 2. Detractors of the view that playing violent video games increases the likelihood of aggressive behaviour also criticise the methodology of video game studies and of meta-analyses of these studies. It is to this important scientific evidence that we now turn. Figure 1: Some longitudinal factors for youth violence Adapted from US Department of Health and Human Services (2001), Bushman and Huesmann (2006) and Anderson et al (2010). 63 The impACT of violenT video gAmes: An overview What is a meta-analysis and what evidence do the meta-analyses provide? A meta-analysis is a statistical technique whereby scientific studies that test the same or a similar hypothesis (for example, that violent video game exposure compared to neutral video game exposure will result in increased aggression) and the same or a similar outcome (for example, aggressive behaviour) are combined to ascertain the strength (“effect size”) of the average finding. To date there have been a number of meta- analyses of the effect of violent video games on aggressive thoughts, feelings and behaviours. In particular, studies by Distinguished Professor Craig Anderson and Dr Chris Ferguson have received a lot of publicity in recent years and it is valuable to compare them. Dr Ferguson, a vocal critic of the research demonstrating a link between violent video game playing and aggression, along with video game industry representatives, claims that violent video game research is methodologically flawed and that mainstream media violence researchers selectively report biased findings. Dr Ferguson has also suggested that Professor Anderson’s meta-analyses have a “publication bias” that undermines their results. Dr Ferguson cites his own three meta-analyses that examine the question of whether violent video game playing increases subsequent aggression. These examined 24, 17 and 14 published papers, encompassing 25, 21 and 15 separate tests of the same hypothesis respectively (Ferguson 2007a, 2007b; Ferguson & Kilburn, 2009). In total, 4205 and 3602 participants were tested in the first two meta-analyses (the number cannot be determined for the most recent study but is assumed to be lower). Dr Ferguson found a positive relation- ship between violent video game exposure and aggressive behaviour, with effect sizes of .29, .14 and .15 respectively. He then inappropriately (according to some meta-analysis experts, see Bushman, Rothstein, & Anderson, 2010) “corrected” for publication bias using a controversial statistical procedure called “trim and fill” that reduced these effect sizes. Such a procedure guesses what unpublished studies might be out there and adds these guesses to the averaging procedure. Based on the “corrected” figures, Dr Ferguson concluded there was no effect of violent video games on aggressive behaviour. These three meta-analyses, which use highly overlapping subsets of the same small sample of studies, are 64 growing up fAsT And furious widely cited as the strongest evidence that violent video game playing does not increase the likelihood of aggressive behaviour. Evidence that playing violent video games does increase the likeli- hood of aggression comes from many researchers. Professor Anderson and his colleagues have themselves conducted a large number of such studies and have also summarised the available studies in three compre- hensive meta-analyses, the first in 2001 (Anderson & Bushman, 2001), the second in 2004 (Anderson et al, 2004) and the most recent in 2010 (Anderson et al, 2010). The latter paper was co-authored by Professor Hannah Rothstein, an expert in meta-analyses and publication bias. This paper detailed major shortcomings in the Ferguson meta-analyses (which failed to include numerous relevant studies) and included all relevant studies then known. Data from 136 articles, 381 separate tests of hypotheses, and across a massive sample of 130, 296 participants were analysed. In this large, all-inclusive meta-analysis, research methodology was also examined. Among the many findings was that studies with better research methods tended to find stronger effects of violent video game playing on aggressive behaviour. We present a summary of the findings in Figure 2 (over page). We understand that the concept of effect size is a hard one to grasp without a detailed knowledge of statistical procedures, so we will provide some comparison data afterwards to help readers make sense of the results. The middle bar shows the effect found, the bars on either side reflect how variable the findings were in the studies tested. Figure 2 shows several meta-analyses. Each tests a different hypoth- esis. All hypotheses are tested as outcomes of exposure to violent video games, and these outcomes include aggressive behaviour, aggressive thoughts (cognitions), aggressive feelings (affects), physiological arousal, desensitisation to violence/low empathy and pro-social behaviour. As can be seen, the average effect across these many studies was one whereby exposure to violent video games led to an increase in aggressive behaviours, aggressive thoughts, aggressive feelings and physiological arousal (which is linked to aggressive behaviour), to desensitisation to violence and decreased empathy, and to a reduction in pro-social behaviours. It is important to note that these findings come from a range of study types – experimental studies in which all participants have exactly the same experience other than the media type they experi- ence, correlational studies of the links between levels of violent video game playing and various types of aggressive behaviours in real life, and longitudinal studies that follow video game playing patterns and behavioural patterns in the same people over time. Each study type makes a unique contribution to what we know. Experiments can be used to infer that one thing causes another, but it is harder to generalise these findings to “real life”. Correlational studies involve “real life” behaviours and can test alternative hypotheses, but it is difficult to determine the causal direction of relationships found (that is, whether playing violent games causes aggression or whether aggressive people choose violent games). Longitudinal studies are real world studies and can be used to find whether one thing causes another over time in a person’s life. Some media violence studies have followed the same people for over 40 years (eg, Huesmann et al, 2003) and have very detailed data. Because links between violent video game playing and aggression are found consistently across all three study types, the evidence converges to suggest both a causal link and an effect that is found in the real world. The Anderson et al (2010) meta-analysis also found that when proper statistical methods are used, there was no evidence of systematic publication bias in the studies. The rather weak evidence of publication bias produced by Dr Ferguson was likely the result of several factors, including failure to use all of the relevant studies and the combining of cross-sectional and experimental studies in the publication bias analysis. To understand how strong the obtained violent video game effect on aggression is, it can be helpful to get a sense of what the “effect size” numbers actually mean. It is easy to understand that a higher number means a stronger effect, but it is much harder to know how a big a number needs to be before it is considered important. Figure 3 shows some effect sizes for well known phenomena that can be used as points for comparison. As can be seen from Figure 3, violent video game effects are larger than the effect of eating calcium on bone mass, of asbestos inhalation Figure 3: The comparative effect sizes of violent video game effects and other well known phenomena * From Best Practices studies, Anderson et al, Psychological Bulletin, 2010. 67 The impACT of violenT video gAmes: An overview on related cancers, of condom use on reducing HIV infection numbers, of taking aspirin on reducing heart attacks and a range of other very important phenomena. Clearly, the size of violent video game effects is large enough to be considered socially important. A final finding from the Anderson et al (2010) meta-analyses is that the violent video game effects occurred for both males and females, and across low-violence collectivistic Eastern countries (for example, Japan) and high-violence individualistic Western countries (for example, Australia and the United States). This is not a surprising finding, as other reviews have found that violent video games affect people regardless of age, gender, socio-economic status, game genre and game system (Barlett et al, 2009). In fact, to the knowledge of the authors, no group has yet been identified that are immune to the effects of exposure to violent media such as video games (see Anderson et al, 2003). Perhaps the best brief summary of the evidence presented here is articulated in a statement produced by 13 researchers into violent video game effects (including the authors of this chapter), prepared for an amicus curiae (friend of the court) brief for the Schwarzenegger and Brown v Video Software Dealers Association and Entertainment Software Association case in the Supreme Court of the United States (Docket # 08-1448). This statement was supported as being accurate by a further 102 well-respected researchers in this area. Statement on Video Game Violence Both the American Psychological Association (APA, 2005) and the American Academy of Pediatrics (AAP, 2009) have issued formal statements stating that scientific research on violent video games clearly shows that such games are causally related to later aggressive behavior in children and adolescents. Extensive research has been conducted over many years using all three major types of research designs (experimental, cross-sectional, and longitudinal). Numerous original empirical research studies have been conducted on children and adolescents. Overall, the research data conclude that exposure to violent video games causes an increase in the likelihood of aggres- sive behavior. The effects are both immediate and long term. Violent video games have measurable and statistically significant effects on both males and females. Theoretically important effects of violent video games have been confirmed by many empirical studies. The effects have been replicated by researchers in different settings and in numerous countries. The psychological processes underlying 68 growing up fAsT And furious such effects are well understood and include: imitation, observa- tional learning, priming of cognitive, emotional and behavioral scripts, physiological arousal, and emotional desensitization. These are general processes that underlie all types of social behavior, not just aggression and violence; they have been confirmed by count- less studies outside of the media violence domain. In addition to causing an increase in the likelihood of aggressive behavior, violent video games have also been found to increase aggressive thinking, aggressive feelings, physiological desensitization to violence, and to decrease pro-social behavior. Importantly, this statement alludes to the psychological processes that are known to underlie the effect of exposure to violent video games on children. These are worth examining in more detail because they also provide some insight as to why the effects of violent video games, compared to other violent media, may be stronger. The psychology of violent video game effects on children Most of the explanations related to violent video game effects involve different types of learning. Because of certain features of violent video game playing – interactivity, repetition and the actual playing of the role of aggressor – the effects may be stronger and patterns of behaviour better learned. Imitation Humans seem to be hard-wired from birth to imitate others. Recently discovered “mirror neurons” in humans and primates represent one mechanism in the brain that may facilitate this (Caggiano et al, 2009; Gallese et al, 1996; Rizzolati et al, 1996; Umilta et al, 2001). Imitation has benefits, including the fast learning of important behaviours, and plays a role in human bonding. However, imitation of unhelpful and anti-social behaviours can have clear negative effects for the individual and for society. We know that children will imitate aggressive behaviours, even if the behaviours are totally new to the child and are not seen to be rewarded in any way (Bandura, 1965; 1973; Bandura et al, 1961; 1963a, 1963b). We also know that children imitate characters from the media they see, with some characters more likely to be imitated than others – those that are attractive, heroic, rewarded for their behaviour or liked, or that have high social status. In violent video games the central characters 69 The impACT of violenT video gAmes: An overview often meet several of these criteria. Does this mean, though, that people will copy the behaviours of the characters in very violent games such as GTA and others? It is possible. For example, an 18-year-old youth in Thailand stabbed a taxi driver to death trying to “find out if it was as easy in real life to rob a taxi as it was in the game” (Reed, 2008). As a result, GTA IV was banned in Thailand. In 2003 William Buckner, 16, and his step-brother Joshua, 14, killed a man and seriously wounded a woman shooting at cars in Tennessee (Calvert, 2003). The boys claimed they were acting out the game Grand Theft Auto III. Also in 2003, Devin Moore, an 18-year-old from Alabama, killed three police officers follow- ing his arrest for a carjacking. On being re-arrested he is reported to have told police that “Life is like a video game. Everybody’s got to die sometime” (Leung, 2005). Again, the killer told police he was copy- ing behaviour he had learned playing GTA III. We are not suggesting that violent video game playing alone was causal in these crimes. As noted earlier, numerous risk factors influence the likelihood of aggressive and violent b ehaviour, and the most severe forms of violence virtually always require the convergence of many risk factors. Furthermore, it is difficult (perhaps impossible) to identify which risk factors were crucial to any particular aggressive or violent act. Nonetheless, imitation of media violence seems to have played some role in these cases. There are numerous other stories of aggressive behaviours that seemingly imitate violent video games. These are easily accessed on the internet with a simple search. Clearly, for some violent video game players, simple imitation may play a causal role in some acts of aggression. However there are a number of other factors, also linked with imitation and learned aggression, that may also be important. Identification Although media effects can occur without the person identifying with any of the characters they have seen, identifying with an aggressor has been shown to increase the likelihood of adopting aggressive behav- iours and attitudes (Cantor, 1994; Huesmann & Eron, 1986; Huesmann et al, 2003). People are more likely to identify with a character who is perceived as similar, heroic and attractive (Hearold, 1986; Heath et al, 1989), and are more likely to identify with and believe realistic portray- als because they are easier to relate to personal experiences (Berkowitz 70 growing up fAsT And furious & Alioto, 1973; Feshback, 1972; Geen, 1975). In violent video games, the player strongly identifies with (and usually takes the role of) the aggres- sor. The aggressive central character is usually glorified and portrayed as heroic and, in recent years, the portrayal of aggressive characters in video games has become increasingly realistic (Gentile et al, 2007). For these reasons, identification with violent/aggressive characters may be a key way that video games impact on children. Repetition It is well established that repetition of behaviours establishes them in memory, increases skill and automates them as learned responses (eg, Gentile & Gentile, 2008). Further, repeating an entire behavioural sequence commits it to memory better than repeating only part of a sequence (Gentile et al, 2007). Violent video games are much more repetitive than other forms of violent media and more often involve the repetition of complete behavioural sequences (Gentile et al, 2007). Players repeat the same behaviours and receive similar rewards throughout the game, experience similar thoughts and feelings during those actions and are exposed to the attitudes espoused in the game implicitly and explicitly (for example, sleeping with prostitutes and then murdering them to retrieve one’s money in GTA implies misogyny, the acceptance of violence to get what one wants and that human life has little value). Simply put, the repetitive nature of violent video games is ideal for learning aggressive attitudes and scripts for behaviour. Interactivity Active participation assists learning as it requires attention, and closely attending to a task assists people to memorise the relevant behaviours and knowledge (Gentile et al, 2007; Gentile & Gentile, 2008). Violent video games are highly interactive, and the recent development of home consoles that allow players to use realistic weapons such as replica guns and swords further increases the level of interactivity and decreases the gap between game playing behaviours and “real world” behaviours. The combination of interactivity and frequent rehearsal is a potent one for learning. In essence, this is a key reason that video games are such powerful tools for teaching pilots, astronauts and soldiers their core skills. These factors give video games tremendous potential for 71 The impACT of violenT video gAmes: An overview pro-social pursuits and as learning tools, but have less welcome implica- tions regarding the interactive rehearsal of anti-social and aggressive behaviours. Lack of negative consequences Another basic tenet of learning theory, demonstrated across thousands of studies, is that people are more likely to behave in ways that are rewarded and less likely to behave in ways that are punished. In terms of imitation, children imitate aggression they perceive as being rewarded more often than aggression they perceive as resulting in punishment. Interestingly, children will imitate unpunished aggression as often as rewarded aggression (eg, see Bandura, 1973). With these facts in mind, it is relevant that most acts of violence in video games: (a) go unpunished; (b) are rewarded (for example, by points, money, status and eleva- tion to higher game levels); (c) have unrealistic consequences for the victim. With relation to the final point, it is important for parents and profession- als to note that seeing victims suffer realistic and negative consequences as a result of media violence should reduce the likelihood of subsequent aggression because pain cues usually inhibit aggressive behaviour (Baron, 1971a, 1971b, 1979). Also note, however, that in some circum- stances pain and suffering cues can increase aggressive behaviour (see Berkowitz, 1993, p 174). Associative learning As noted in Chapter 1, the brain is a neural network in which concepts, ideas, feelings and memories are stored and interconnected. The way this network “wires up” depends on what people experience, with paired experiences (such as the smell of fresh coffee, pleasure and a craving for a hot beverage) becoming more strongly wired together the more they are experienced together. This means that people learn to associate one thing with another. In media generally, and in violent video games especially, many things are frequently paired and thus become “wired” together. For 72 growing up fAsT And furious example, guns are rarely used for any purpose other than violent action. This is why there is a well demonstrated “weapons effect”, whereby the simple sight of a weapon increases the likelihood of aggression if the person has mentally paired a weapon such as a gun with killing or hurting people rather than with a non-aggressive use such as sports shooting (Bartholow et al, 2005; Berkowitz & LePage, 1967; Carlson et al, 1990). This suggests that children who often play video games where there is frequent weapon use for the purpose of killing and hurting others are more likely to be aggressive immediately after playing the game and are more likely to be aggressive when exposed to a weapon of a similar type in real life. Associative learning also explains why whole sequences of behav- iour are learned during video game play and why the acquisition of aggression-related knowledge structures is so important. Acquisition of aggressive knowledge structures, attitudes and scripts for behaviour Clearly, violent video games are powerful teachers, but what is the outcome of such learning for the individual child? In essence, the child (and adult for that matter) internalises clusters of associated knowledge about aggressive behaviour (knowledge structures or “schemas”), as well as attitudes about aggressive behaviour and “scripts” for how to behave in certain circumstances. Schemas and scripts contain knowledge about an aspect of living, mental links to related attitudes, feelings and memories, and a repertoire of associated behaviours. Scripts additionally contain information about how commonly experienced situations “play out” (such as visiting a supermarket) and the typical sequence of behaviours in that situation (entrance at the left of the store, grab a trolley, milk at the back, bread in the second aisle, line up and pay). Schemas and scripts are activated by a trigger (for example, the supermarket logo) and, once active, help to direct our behaviour, often without our being aware of it. Children start to develop schemas about the world as toddlers (and perhaps earlier) and these can sometimes be aggressive in nature. In relation to the development of aggressive knowledge structures and attitudes, there is considerable evidence that exposure to violent media (including violent video games): 73 The impACT of violenT video gAmes: An overview (a) increases attitudes approving of aggressive behaviour as a “normal” social response (Huesmann, 1998); (b) increases mental access to scripts for resolving conflict that involve aggressive behaviour and reduces access to conflict- solving scripts that are non-aggressive (Bushman & Anderson, 2002; Huesmann, 1998); (c) underpins the attitude that aggression is (1) exciting and (2) increases one’s social status (Groebel, 1998); (d) increases the belief that the world is a frightening place (Cantor, 2003; Donnerstein et al, 1994); (e) increases a hostile attributional bias whereby ambiguous but innocent behaviours by others are interpreted as deliberately hurtful (Anderson et al, 2010; Möller & Krahé, 2009); and (f) increases the likelihood of aggressive behaviour (Anderson et al, 2010). Regrettably, children are exposed to a lot of violent media. As noted in Chapter 1, by the age of 18, most US children will have seen many tens of thousands of murders and acts of violence on television alone. Heavy playing of violent video games that involve frequently killing of other people or creatures would add greatly to those figures, especially for murders. This means that for a lot of children, violent media influences may result in higher levels of aggressive schemas, fear about the wider world, hostile and anti-social attitudes, and scripts for behaving aggres- sively, than might otherwise occur without those influences. Fictitious violence versus real violence Recent brain imaging studies, in which children’s brain activation patterns are “photographed” by fMRI machines whilst they are expe- riencing violent media, have shown that even when children know the violence they are watching is fictitious or fantasy violence, their brains respond to the violence as if there was a real threat (Murray et al, 2006; see also Weber et al, 2006). In addition, long-term memory systems were activated, suggesting that this effect could endure beyond the initial exposure. This research suggests that fantasy media violence seems to have a similar impact on children as exposure to realistic media violence. The General Aggression Model The General Aggression Model (GAM: Anderson & Bushman 2002; DeWall, Anderson & Bushman, in press) provides a theoretically sound and helpful way of understanding how exposure to violent media can increase a person’s likelihood of being aggressive in both the short and long term (see Figures 4 and 5). The GAM is a model of what is happening psychologically during an episode of aggression. In essence the person brings their own readiness to aggress, through their gender, beliefs and attitudes about aggres- sion, personality and other stable factors. Each situation has cues and triggers for aggression, such as the presence of a weapon or an insult. When a person encounters an aggression-triggering situation, various relevant cognitions (memories, beliefs, attitudes, scripts for behaviour) are activated, along with feelings (such as fear and anger) and a level of physiological arousal. Higher levels of arousal make a dominant tendency to act more likely. Figure 4: The General Aggression Model 75 The impACT of violenT video gAmes: An overview As a result of these activated cognitions and feelings, and of the level of arousal, the person has an immediate response. If they are very aroused or if the situation requires immediate action, this will probably be the ultimate response. If the person has the time and cognitive capac- ity for a more considered response they will evaluate their options and are more likely to make a thought-through response. Either way, the eventual response, which may be aggressive, is enacted, elicits a social response and the episode is encoded into memory. Once in memory, it becomes part of the “person” and can then affect their responses to future situations. Although “person” characteristics are very important in deter- mining how an individual reacts in a specific situation, the research presented in this chapter reveals that most people, regardless of personal characteristics, are influenced by violent video games. It also reveals that violent video games provide many cues for aggressive behaviour, activate aggressive cognitions and feelings, and can increase levels of arousal. These internal processes can explain why there is also a robust link between violent video game playing and aggressive behaviour. Over the long term, exposure to the attitudes, ideas and scripts for behaviour in violent video games leads to stable knowledge structures, attitudes, biases in thinking, scripts for conflict resolution and action tendencies that include aggressive behaviour (see Figure 5). In turn, these increase the base level of aggressiveness in that person’s personal- ity and bring the person to an aggression-triggering type of situation with a higher predisposition to aggress. Between the two models, it is easy to see how playing a video game can lead to aggression in the short term, and how repeated playing can lead to higher levels of aggression in the long term. Conclusions and advice for parents and professionals working with children In this chapter we have detailed the evidence that video games can be used for a wide array of helpful purposes, but that there can be many negative consequences for playing violent games, especially when played excessively. This raises an important question: “How do we help children to benefit from video games but escape their negative impacts?” In Chapter 1 it was noted that the “you are what you eat” principle applies to the way media exposure affects the way the human neural network “wires up” as well as to food consumption. Using the food metaphor can be helpful for parents and professionals when it comes to advising children on how to use media in a beneficial way. Through 77 The impACT of violenT video gAmes: An overview school education many children are interested in healthy eating and this can be extended to maintaining a healthy media diet. For example, children could be told that, as with food, there are media that are good to consume regularly (in moderation), media that are for infrequent consumption and media that children should avoid. Helping a child to self-regulate what they watch and hear in the media can be very important to a child’s development in this media saturated world. This may involve: • educating children about media effects generally and about video game effects specifically, so that children can learn to make informed choices; • helping children to limit their time playing video games; • encouraging children to play pro-social and educational video games in preference to violent games; • keeping video game consoles in public areas and out of children’s bedrooms; and • playing video games with your children so that you are aware of their content and can knowledgeably discuss the implications of playing certain types of games and screen out potentially harmful ones. It is desirable for children to be able use video games for a range of educational and developmental objectives, but to have less exposure to the more harmful impacts. We hope that this chapter has helped to dispel some popular myths about the impact of violent video games on children and adolescents and has clarified for readers how positive outcomes might be achieved. A Tragic Postscript I see MW2 more as a part of my training-simulation than anything else … You can more or less completely simulate actual operations These were the chilling words with which Anders Behring Breivik referred to the computer game Modern Warfare 2 in a 1500-page mani- festo disseminated just hours before he was responsible for the deaths of 76 of his fellow Norwegians (Moses, 2011; Shah, 2011; Townsend & Tisdall, 2011). The 32-year-old male behind the now infamous bombing 78 growing up fAsT And furious of government buildings in Oslo and subsequent shooting massacre on Utoya island on 22 July 2011 made no secret of the fact that playing the violent video games Modern Warfare 2 and World of Warcraft aided him in preparing and executing his attacks. Breivik identified Modern Warfare 2 as helping him with “target practice” (Shah, 2011) and involvement with World of Warcraft as providing sufficient cover for his preparatory activities (Moses, 2011). As a result of the attacks, one of Norway’s biggest retailers, Coop Norway, issued a ban of indefinite duration on these and other violent video games that, at the time of publication, has yet to be lifted (Narcisse, 2011; Navarro, 2011). When considering the impact of violent video games, particularly in light of the Norway atrocities, it should also be noted that video games in which acts of violence are executed in first-person, immersive environments have long been recognised and used by the US military forces as effec- tive in both the training and recruitment of their members (Holguin, 2009; Robson, 2008).
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When asked a question, you should only use the information within the provided context to form your answer. If you can't answer a question using the given context, reply with "I don't have that information, did you have any other questions?". Limit your answers to 200 words or less. Parents often ask about the effects of violent video games on their children and teenagers. In most cases, they note that their “common sense” instinct is that too much exposure to violent video games must have some sort of negative effect on their children, but that they have read in the media that “the jury is still out” on violent media effects or that there is no convincing evidence that violent video game playing is harmful. Confusion around this conflict will often prompt them then to ask: “what does the scientific evidence really say?” In this chapter we show that the common sense view is backed up by a substantial body of recent scientific findings. Helpful and pro-social video game content has great potential for enhancing the lives of children and adolescents, but exposure to anti-social and violent video game content increases the likelihood of a range of negative outcomes, with greater exposure increasing the risk. Video games have been around for nearly 50 years. Kirsch (2010) notes the first as being Spacewar (released in 1962), a game in which two spaceships battle to the death in space. Although the graphics were very simple compared to modern games, the theme of battling to the death is one that has endured through the ensuing five decades. According to the most recent comprehensive poll by the Kaiser Foundation, American children aged 8–18 play an average of eight hours of video games per week, an increase of over 400 per cent from 1999 (Rideout, Foehr & Roberts, 2010). Playing is heaviest in the 11–14 age group, with boys outplaying girls more than 2.5 hours to 1. A recent study suggests that around 99 per cent of American boys play video games, along with 94 per cent of girls (Lenhart et al, 2008). It is common for US children and adolescents to play more than 20 hours per week 56Chapter in W. Warburton & D. Braunstein (Eds.) Growing Up Fast and Furious: Reviewing the Impacts of Violent and Sexualised Media on Children, (pp. 56-84). Annandale, NSW, Australia: The Federation Press. and it is not uncommon for males to play 40 hours or more per week (Bailey, West & Anderson, 2010). On average, Australian 7–18-year-olds played somewhat less than their US counterparts in 2007 (4.7 hours per week: see ACMA, 2007), but this figure could have risen substantially in recent years if Australian children have followed the steep upward trend found in the latest US studies. The types of games vary, but content analyses by Dill and colleagues (2005) show that the majority of top selling video games and children’s favourite games contain violence, and often strong violence. More recently, Call of Duty: Modern Warfare 2 grossed ~$USD 550 million in the first five days of its 2009 release, at that time more than any other entertainment product in history (movies included). Next on the list in 2009 was Grant Theft Auto IV (GTA), with ~$USD 500 million in five days. Even more recently (a year is a long time in the video game world) Call of Duty: Black Ops grossed $USD 360 million in a single day, breaking all records (Ortutay, 2010). According to Wikipedia, the massive multiplayer online game (MMOG) World of Warcraft has more than 12 million online subscribers and thus currently grosses more than $USD 180 million per month (at $15 per month per player). GTA, which is rated M17+ in the United States and involves such activities as going on murderous rampages, having sex with prostitutes and then murdering them to retrieve the money paid, has been played by 56 per cent of United States children aged 8–18 (Rideout et al, 2010). Clearly, a large number of children and adolescents are exposed regularly to video games with high levels of violence and anti-social themes. This makes it important for parents, educators and professionals who work with children to have some knowledge of their effects. Before turning to the negative effects of violent video games however, it is important to stress that video games can have many helpful benefits. Here are just a few. Helpful effects of video games Pain management Kirsch (2010) notes that various media, including video games, can be used to distract and relax children during painful medical procedures. 57 The impACT of violenT video gAmes: An overview Coordination and spatial cognition A number of studies reveal that video games which require the place- ment of objects within a screen (such as Tetris) can enhance the spatial cognition abilities of players (that is, the ability to mentally arrange and rotate objects in three dimensions). Indeed, video game playing has been linked with a wide array of visual and spatial skills, primarily through practice effects (see Green & Bavelier, 2006; Okagaki & Frensch, 1994; see also Bailey et al, 2010, for a review). In one study by Gopher, Weil and Bareket (1994), the flight performance of Israeli Air Force cadets who had been trained on the Space Fortress II video game was compared with the performance of an untrained group. The trained cadets performed better in almost all aspects of flight performance and as a result the game was incorporated into the Israeli Air Force training program. Pro-social behaviour Although this area of study is still in its infancy, there is mounting evidence that video games which model and involve participants in pro- social, helping behaviours can lead to increases in pro-social behaviour in the short and long term. Most notably, Gentile et al (2009) found that elementary school students exposed to pro-social video games were more helpful than those exposed to violent or non-social video games. In a second longitudinal study of Japanese children in grades 5, 8 and 11, exposure to pro-social video games at the start of the study was linked with increased pro-social behaviour some months later, even when the baseline pro-social tendencies of children were statistically removed. In a final study of Singaporean secondary school students, the amount of pro-social video game play experienced was correlated with helping behaviour, cooperation, sharing and empathy. A study by Greitemeyer and Osswald (2009) found that pro-social video game playing led to a short-term reduction in the tendency to see the world as hostile and an immediate reduction in anti-social thoughts. Education A considerable literature reveals video games to be a powerful teaching tool (eg, Barlett et al, 2009; Murphy et al, 2002; Swing & Anderson, 58 growing up fAsT And furious 2008). They have been used to teach algebra (Corbett et al, 2001), biol- ogy (Ybarrondo, 1984), photography (Abrams, 1986), and computer programming (Kahn, 1999), to teach children how to manage diabetes (Lieberman, 2001; 2006) and to teach specific skills using simulators (for example, by Qantas pilots, NASA and the Air Force). Gentile and Gentile (2008) describe the educational advantages of using video games as teaching tools. These include the power of video games to engage children and to “encourage children to persevere in acquiring and mastering a number of skills, to navigate through complex problems and changing environments, and to experiment with different identities until success is achieved” (p 127). Exercise There has been a recent explosion in the popularity of video games that promote physical activity and exercise (that is, “Exergames”). Games such as Wii Sports Heart Rate; Wii Fit; Wii Play; Wii FitPlus; Dance, Dance Revolution and Just Dance seem to be part of a recent trend that has seen an increase in the availability and popularity of non-violent, helpful games. Clearly, video games have considerable potential to enhance the lives of children and adolescents. Unfortunately, excessive video game playing, especially of violent video games, has the potential to impact children in a number of negative ways. Harmful effects of video games Video game addiction In his moving biography, Unplugged: My Journey into the Dark World of Video Game Addiction, Ryan Van Cleave describes the way that a violent online game, World of Warcraft, dominated his life to such an extent that he was unable to function normally and was driven to the verge of suicide. Video game addiction is now taken so seriously by psychologists and psychiatrists that it was recently considered for inclusion in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) as a diagnosable psychiatric disorder and has been lodged in its appendix to encourage further research. It is clear that many children 59 The impACT of violenT video gAmes: An overview play video games at a “pathological” level that causes damage to family, social, school or psychological functioning (see Anderson et al, 2012). For example, it has been found that 8.5 per cent of 8–18-year-old US video game players do so at pathological levels (Gentile, 2009). Similar studies have found figures of 11.9 per cent in Europe (Grusser et al, 2007), 8.7 per cent in Singapore (Choo et al, 2010), 10.3 per cent in China (Peng & Li, 2009) and 4 per cent for 12–18-year-olds in Norway (Johansson & Götestam, 2004), with a further 15.5 per cent “at risk”. As will be seen in the ensuing sections, the amount that children play video games is very important. Those who play excessively are not only at risk of a number of negative outcomes, they are also much more likely to be playing violent games (see Krahé & Möller, 2004). Attention deficits There are some studies linking the amount of time children spend play- ing video games to attention deficits, impulsivity and hyperactivity (see Bailey et al, 2010; Swing et al, 2010). For example, Gentile (2009) found that adolescents who used video games at pathological levels were nearly three times more likely to be diagnosed with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder than adolescents who played at non-pathological levels. In a landmark paper, Swing and colleagues (2010) examined the effect of video game playing on atten- tion in elementary school children. They used a longitudinal study that statistically controlled for a range of other factors that could also lead to attention problems and found that amount of time spent playing video games predicted increases in teacher assessments of attention deficits in the children 13 months later. These results suggest that the children’s level of video game playing played a causal role in their subsequent loss of attentional capacity. Anderson et al (2012) believe that on theoretical grounds some video games should have less effect on attentional problems (for exam- ple, those that require controlled thought and planning) and that those which require constant reactive behaviours from players (a common feature of many violent first person shooting games for example) may be more problematic in terms of children developing attentional difficulties. 60 growing up fAsT And furious School performance It is well established that spending longer hours playing video games is linked with poorer school performance for both children and adoles- cents (Anderson et al, 2007; Chan & Rabinowitz, 2006; Chiu et al, 2004; Cordes & Miller, 2000; Gentile, 2009; Gentile et al, 2004; Sharif & Sargent, 2006). One explanation for this is a simple displacement of time – hours spent playing video games eats into time that would normally be spent studying and reading. For example, in a study of 1491 youth between 10 and 19, gamers spent 30 per cent less time reading and 34 per cent less time doing homework (Cummings & Vandewater, 2007). It is also possible, however, that children who perform more poorly at school are also more likely to “spend more time playing games, where they may feel a sense of mastery that eludes them at school” (Anderson et al, 2012). Of course, another possibility is the that excessive gaming creates attention deficits, which in turn can lead to poorer school performance. Increased aggression Should we be concerned about children and adolescents playing violent video games? Can this lead to aggressive behaviour? Over 98 per cent of paediatricians in the United States have considered these questions and believe that excessive violent media exposure has a negative effect on childhood aggression (Gentile et al, 2004). Similarly, there is a consen- sus amongst the vast majority of violent video game researchers that too much exposure to violent video games increases the likelihood of aggressive thoughts, feelings and behaviours, leads to desensitisation to violence and also leads to decreases in pro-social behaviours and empathy (Anderson et al, 2010; Huesmann, 2010). There are, however, a small number of researchers who dispute this evidence and it seems that the views of this small minority have had a large impact on public perceptions (Anderson & Gentile, 2008; Dill, 2009). In this section of the chapter we will broadly examine the arguments for this view and then review the scientific evidence that does find violent video game effects. In this way, we hope that readers can judge the evidence for themselves. 1. The first argument against violent video game effects is that there is little evidence linking the playing of violent video games to very violent behaviours (such as school shootings). To better understand 61 The impACT of violenT video gAmes: An overview this argument it is helpful to reflect on the difference between aggres- sion and violence. In essence, violence is aggressive behaviour that has extreme harm as its goal (Anderson & Bushman, 2002). Thus, all violence is aggression but not all aggression is violence. With this in mind we make four points. (a) Ethically it is not possible to use the most powerful methods – experi- mental manipulations – to test the causal link between violent video games and violence because we cannot rightfully incite people to cause extreme harm in a laboratory. There are, however, ways to test links with aggressive behaviour, which can be examined ethi- cally in a laboratory. It is disingenuous to suggest that because there are no experimental studies that randomly assign children to years of playing violent or nonviolent video games and then measure which group commits the most violent crimes, that therefore there are no established negative or anti-social effects. This is like saying that because there are no experimental studies on humans showing that cigarette smoking causes lung cancer, smoking is not a causal risk factor. The causal links between violent video game playing and physical aggression are, in our opinion, well established. (b) Cross-sectional (correlational) studies and longitudinal studies of violent video game effects have established significant links to violent behaviour. Several longitudinal studies in particular provide strong evidence that these are causal effects. (c) Aggressive behaviour, which can include bullying, hurting other people physically, hurting other people’s property or relationships and hurting people verbally, is a very important social phenomenon in its own right. Aggression does not have to escalate into violence to be harmful and destructive. (d) No aggression researchers claim that media violence is the sole or even the most important source of violent behaviour. The most common approach, and the one taken by the authors, is the “risk factor” approach. According to this approach, people can have vari- ous risk factors for aggression or violent behaviour (see Figure 1). These might include coming from a violent home, having a violent peer group, high levels of trait aggression, exposure to violent media and a number of other factors. The more risk factors that are present for a person, especially when they are present from a young age, the more likely that person is to be aggressive or violent. Strasburger (2009, p 203) notes that: The research on media violence and its relationship to real-life aggression is clear: young people learn their attitudes about violence at a very young age, and once learned, those attitudes are difficult to change (Anderson et al, 2003; Bushman & Huesmann, 2006). Conservative estimates are that media violence may be causing 10% of real-life violence – not the leading cause by any means, but an unhealthy chunk that we could do something about if we chose to (Strasburger et al, 2009; Comstock & Strasburger, 1990). We believe that Victor Strasburger is right. Many risk factors for aggression and violence are very hard to deal with as parents, as educators, as professionals and as policy-makers. Media violence, though, is one risk factor that can be controlled and about which action can be taken from the level of the individual home through to the level of State and federal governments. This makes the research on media violence effects particularly important. 2. Detractors of the view that playing violent video games increases the likelihood of aggressive behaviour also criticise the methodology of video game studies and of meta-analyses of these studies. It is to this important scientific evidence that we now turn. Figure 1: Some longitudinal factors for youth violence Adapted from US Department of Health and Human Services (2001), Bushman and Huesmann (2006) and Anderson et al (2010). 63 The impACT of violenT video gAmes: An overview What is a meta-analysis and what evidence do the meta-analyses provide? A meta-analysis is a statistical technique whereby scientific studies that test the same or a similar hypothesis (for example, that violent video game exposure compared to neutral video game exposure will result in increased aggression) and the same or a similar outcome (for example, aggressive behaviour) are combined to ascertain the strength (“effect size”) of the average finding. To date there have been a number of meta- analyses of the effect of violent video games on aggressive thoughts, feelings and behaviours. In particular, studies by Distinguished Professor Craig Anderson and Dr Chris Ferguson have received a lot of publicity in recent years and it is valuable to compare them. Dr Ferguson, a vocal critic of the research demonstrating a link between violent video game playing and aggression, along with video game industry representatives, claims that violent video game research is methodologically flawed and that mainstream media violence researchers selectively report biased findings. Dr Ferguson has also suggested that Professor Anderson’s meta-analyses have a “publication bias” that undermines their results. Dr Ferguson cites his own three meta-analyses that examine the question of whether violent video game playing increases subsequent aggression. These examined 24, 17 and 14 published papers, encompassing 25, 21 and 15 separate tests of the same hypothesis respectively (Ferguson 2007a, 2007b; Ferguson & Kilburn, 2009). In total, 4205 and 3602 participants were tested in the first two meta-analyses (the number cannot be determined for the most recent study but is assumed to be lower). Dr Ferguson found a positive relation- ship between violent video game exposure and aggressive behaviour, with effect sizes of .29, .14 and .15 respectively. He then inappropriately (according to some meta-analysis experts, see Bushman, Rothstein, & Anderson, 2010) “corrected” for publication bias using a controversial statistical procedure called “trim and fill” that reduced these effect sizes. Such a procedure guesses what unpublished studies might be out there and adds these guesses to the averaging procedure. Based on the “corrected” figures, Dr Ferguson concluded there was no effect of violent video games on aggressive behaviour. These three meta-analyses, which use highly overlapping subsets of the same small sample of studies, are 64 growing up fAsT And furious widely cited as the strongest evidence that violent video game playing does not increase the likelihood of aggressive behaviour. Evidence that playing violent video games does increase the likeli- hood of aggression comes from many researchers. Professor Anderson and his colleagues have themselves conducted a large number of such studies and have also summarised the available studies in three compre- hensive meta-analyses, the first in 2001 (Anderson & Bushman, 2001), the second in 2004 (Anderson et al, 2004) and the most recent in 2010 (Anderson et al, 2010). The latter paper was co-authored by Professor Hannah Rothstein, an expert in meta-analyses and publication bias. This paper detailed major shortcomings in the Ferguson meta-analyses (which failed to include numerous relevant studies) and included all relevant studies then known. Data from 136 articles, 381 separate tests of hypotheses, and across a massive sample of 130, 296 participants were analysed. In this large, all-inclusive meta-analysis, research methodology was also examined. Among the many findings was that studies with better research methods tended to find stronger effects of violent video game playing on aggressive behaviour. We present a summary of the findings in Figure 2 (over page). We understand that the concept of effect size is a hard one to grasp without a detailed knowledge of statistical procedures, so we will provide some comparison data afterwards to help readers make sense of the results. The middle bar shows the effect found, the bars on either side reflect how variable the findings were in the studies tested. Figure 2 shows several meta-analyses. Each tests a different hypoth- esis. All hypotheses are tested as outcomes of exposure to violent video games, and these outcomes include aggressive behaviour, aggressive thoughts (cognitions), aggressive feelings (affects), physiological arousal, desensitisation to violence/low empathy and pro-social behaviour. As can be seen, the average effect across these many studies was one whereby exposure to violent video games led to an increase in aggressive behaviours, aggressive thoughts, aggressive feelings and physiological arousal (which is linked to aggressive behaviour), to desensitisation to violence and decreased empathy, and to a reduction in pro-social behaviours. It is important to note that these findings come from a range of study types – experimental studies in which all participants have exactly the same experience other than the media type they experi- ence, correlational studies of the links between levels of violent video game playing and various types of aggressive behaviours in real life, and longitudinal studies that follow video game playing patterns and behavioural patterns in the same people over time. Each study type makes a unique contribution to what we know. Experiments can be used to infer that one thing causes another, but it is harder to generalise these findings to “real life”. Correlational studies involve “real life” behaviours and can test alternative hypotheses, but it is difficult to determine the causal direction of relationships found (that is, whether playing violent games causes aggression or whether aggressive people choose violent games). Longitudinal studies are real world studies and can be used to find whether one thing causes another over time in a person’s life. Some media violence studies have followed the same people for over 40 years (eg, Huesmann et al, 2003) and have very detailed data. Because links between violent video game playing and aggression are found consistently across all three study types, the evidence converges to suggest both a causal link and an effect that is found in the real world. The Anderson et al (2010) meta-analysis also found that when proper statistical methods are used, there was no evidence of systematic publication bias in the studies. The rather weak evidence of publication bias produced by Dr Ferguson was likely the result of several factors, including failure to use all of the relevant studies and the combining of cross-sectional and experimental studies in the publication bias analysis. To understand how strong the obtained violent video game effect on aggression is, it can be helpful to get a sense of what the “effect size” numbers actually mean. It is easy to understand that a higher number means a stronger effect, but it is much harder to know how a big a number needs to be before it is considered important. Figure 3 shows some effect sizes for well known phenomena that can be used as points for comparison. As can be seen from Figure 3, violent video game effects are larger than the effect of eating calcium on bone mass, of asbestos inhalation Figure 3: The comparative effect sizes of violent video game effects and other well known phenomena * From Best Practices studies, Anderson et al, Psychological Bulletin, 2010. 67 The impACT of violenT video gAmes: An overview on related cancers, of condom use on reducing HIV infection numbers, of taking aspirin on reducing heart attacks and a range of other very important phenomena. Clearly, the size of violent video game effects is large enough to be considered socially important. A final finding from the Anderson et al (2010) meta-analyses is that the violent video game effects occurred for both males and females, and across low-violence collectivistic Eastern countries (for example, Japan) and high-violence individualistic Western countries (for example, Australia and the United States). This is not a surprising finding, as other reviews have found that violent video games affect people regardless of age, gender, socio-economic status, game genre and game system (Barlett et al, 2009). In fact, to the knowledge of the authors, no group has yet been identified that are immune to the effects of exposure to violent media such as video games (see Anderson et al, 2003). Perhaps the best brief summary of the evidence presented here is articulated in a statement produced by 13 researchers into violent video game effects (including the authors of this chapter), prepared for an amicus curiae (friend of the court) brief for the Schwarzenegger and Brown v Video Software Dealers Association and Entertainment Software Association case in the Supreme Court of the United States (Docket # 08-1448). This statement was supported as being accurate by a further 102 well-respected researchers in this area. Statement on Video Game Violence Both the American Psychological Association (APA, 2005) and the American Academy of Pediatrics (AAP, 2009) have issued formal statements stating that scientific research on violent video games clearly shows that such games are causally related to later aggressive behavior in children and adolescents. Extensive research has been conducted over many years using all three major types of research designs (experimental, cross-sectional, and longitudinal). Numerous original empirical research studies have been conducted on children and adolescents. Overall, the research data conclude that exposure to violent video games causes an increase in the likelihood of aggres- sive behavior. The effects are both immediate and long term. Violent video games have measurable and statistically significant effects on both males and females. Theoretically important effects of violent video games have been confirmed by many empirical studies. The effects have been replicated by researchers in different settings and in numerous countries. The psychological processes underlying 68 growing up fAsT And furious such effects are well understood and include: imitation, observa- tional learning, priming of cognitive, emotional and behavioral scripts, physiological arousal, and emotional desensitization. These are general processes that underlie all types of social behavior, not just aggression and violence; they have been confirmed by count- less studies outside of the media violence domain. In addition to causing an increase in the likelihood of aggressive behavior, violent video games have also been found to increase aggressive thinking, aggressive feelings, physiological desensitization to violence, and to decrease pro-social behavior. Importantly, this statement alludes to the psychological processes that are known to underlie the effect of exposure to violent video games on children. These are worth examining in more detail because they also provide some insight as to why the effects of violent video games, compared to other violent media, may be stronger. The psychology of violent video game effects on children Most of the explanations related to violent video game effects involve different types of learning. Because of certain features of violent video game playing – interactivity, repetition and the actual playing of the role of aggressor – the effects may be stronger and patterns of behaviour better learned. Imitation Humans seem to be hard-wired from birth to imitate others. Recently discovered “mirror neurons” in humans and primates represent one mechanism in the brain that may facilitate this (Caggiano et al, 2009; Gallese et al, 1996; Rizzolati et al, 1996; Umilta et al, 2001). Imitation has benefits, including the fast learning of important behaviours, and plays a role in human bonding. However, imitation of unhelpful and anti-social behaviours can have clear negative effects for the individual and for society. We know that children will imitate aggressive behaviours, even if the behaviours are totally new to the child and are not seen to be rewarded in any way (Bandura, 1965; 1973; Bandura et al, 1961; 1963a, 1963b). We also know that children imitate characters from the media they see, with some characters more likely to be imitated than others – those that are attractive, heroic, rewarded for their behaviour or liked, or that have high social status. In violent video games the central characters 69 The impACT of violenT video gAmes: An overview often meet several of these criteria. Does this mean, though, that people will copy the behaviours of the characters in very violent games such as GTA and others? It is possible. For example, an 18-year-old youth in Thailand stabbed a taxi driver to death trying to “find out if it was as easy in real life to rob a taxi as it was in the game” (Reed, 2008). As a result, GTA IV was banned in Thailand. In 2003 William Buckner, 16, and his step-brother Joshua, 14, killed a man and seriously wounded a woman shooting at cars in Tennessee (Calvert, 2003). The boys claimed they were acting out the game Grand Theft Auto III. Also in 2003, Devin Moore, an 18-year-old from Alabama, killed three police officers follow- ing his arrest for a carjacking. On being re-arrested he is reported to have told police that “Life is like a video game. Everybody’s got to die sometime” (Leung, 2005). Again, the killer told police he was copy- ing behaviour he had learned playing GTA III. We are not suggesting that violent video game playing alone was causal in these crimes. As noted earlier, numerous risk factors influence the likelihood of aggressive and violent b ehaviour, and the most severe forms of violence virtually always require the convergence of many risk factors. Furthermore, it is difficult (perhaps impossible) to identify which risk factors were crucial to any particular aggressive or violent act. Nonetheless, imitation of media violence seems to have played some role in these cases. There are numerous other stories of aggressive behaviours that seemingly imitate violent video games. These are easily accessed on the internet with a simple search. Clearly, for some violent video game players, simple imitation may play a causal role in some acts of aggression. However there are a number of other factors, also linked with imitation and learned aggression, that may also be important. Identification Although media effects can occur without the person identifying with any of the characters they have seen, identifying with an aggressor has been shown to increase the likelihood of adopting aggressive behav- iours and attitudes (Cantor, 1994; Huesmann & Eron, 1986; Huesmann et al, 2003). People are more likely to identify with a character who is perceived as similar, heroic and attractive (Hearold, 1986; Heath et al, 1989), and are more likely to identify with and believe realistic portray- als because they are easier to relate to personal experiences (Berkowitz 70 growing up fAsT And furious & Alioto, 1973; Feshback, 1972; Geen, 1975). In violent video games, the player strongly identifies with (and usually takes the role of) the aggres- sor. The aggressive central character is usually glorified and portrayed as heroic and, in recent years, the portrayal of aggressive characters in video games has become increasingly realistic (Gentile et al, 2007). For these reasons, identification with violent/aggressive characters may be a key way that video games impact on children. Repetition It is well established that repetition of behaviours establishes them in memory, increases skill and automates them as learned responses (eg, Gentile & Gentile, 2008). Further, repeating an entire behavioural sequence commits it to memory better than repeating only part of a sequence (Gentile et al, 2007). Violent video games are much more repetitive than other forms of violent media and more often involve the repetition of complete behavioural sequences (Gentile et al, 2007). Players repeat the same behaviours and receive similar rewards throughout the game, experience similar thoughts and feelings during those actions and are exposed to the attitudes espoused in the game implicitly and explicitly (for example, sleeping with prostitutes and then murdering them to retrieve one’s money in GTA implies misogyny, the acceptance of violence to get what one wants and that human life has little value). Simply put, the repetitive nature of violent video games is ideal for learning aggressive attitudes and scripts for behaviour. Interactivity Active participation assists learning as it requires attention, and closely attending to a task assists people to memorise the relevant behaviours and knowledge (Gentile et al, 2007; Gentile & Gentile, 2008). Violent video games are highly interactive, and the recent development of home consoles that allow players to use realistic weapons such as replica guns and swords further increases the level of interactivity and decreases the gap between game playing behaviours and “real world” behaviours. The combination of interactivity and frequent rehearsal is a potent one for learning. In essence, this is a key reason that video games are such powerful tools for teaching pilots, astronauts and soldiers their core skills. These factors give video games tremendous potential for 71 The impACT of violenT video gAmes: An overview pro-social pursuits and as learning tools, but have less welcome implica- tions regarding the interactive rehearsal of anti-social and aggressive behaviours. Lack of negative consequences Another basic tenet of learning theory, demonstrated across thousands of studies, is that people are more likely to behave in ways that are rewarded and less likely to behave in ways that are punished. In terms of imitation, children imitate aggression they perceive as being rewarded more often than aggression they perceive as resulting in punishment. Interestingly, children will imitate unpunished aggression as often as rewarded aggression (eg, see Bandura, 1973). With these facts in mind, it is relevant that most acts of violence in video games: (a) go unpunished; (b) are rewarded (for example, by points, money, status and eleva- tion to higher game levels); (c) have unrealistic consequences for the victim. With relation to the final point, it is important for parents and profession- als to note that seeing victims suffer realistic and negative consequences as a result of media violence should reduce the likelihood of subsequent aggression because pain cues usually inhibit aggressive behaviour (Baron, 1971a, 1971b, 1979). Also note, however, that in some circum- stances pain and suffering cues can increase aggressive behaviour (see Berkowitz, 1993, p 174). Associative learning As noted in Chapter 1, the brain is a neural network in which concepts, ideas, feelings and memories are stored and interconnected. The way this network “wires up” depends on what people experience, with paired experiences (such as the smell of fresh coffee, pleasure and a craving for a hot beverage) becoming more strongly wired together the more they are experienced together. This means that people learn to associate one thing with another. In media generally, and in violent video games especially, many things are frequently paired and thus become “wired” together. For 72 growing up fAsT And furious example, guns are rarely used for any purpose other than violent action. This is why there is a well demonstrated “weapons effect”, whereby the simple sight of a weapon increases the likelihood of aggression if the person has mentally paired a weapon such as a gun with killing or hurting people rather than with a non-aggressive use such as sports shooting (Bartholow et al, 2005; Berkowitz & LePage, 1967; Carlson et al, 1990). This suggests that children who often play video games where there is frequent weapon use for the purpose of killing and hurting others are more likely to be aggressive immediately after playing the game and are more likely to be aggressive when exposed to a weapon of a similar type in real life. Associative learning also explains why whole sequences of behav- iour are learned during video game play and why the acquisition of aggression-related knowledge structures is so important. Acquisition of aggressive knowledge structures, attitudes and scripts for behaviour Clearly, violent video games are powerful teachers, but what is the outcome of such learning for the individual child? In essence, the child (and adult for that matter) internalises clusters of associated knowledge about aggressive behaviour (knowledge structures or “schemas”), as well as attitudes about aggressive behaviour and “scripts” for how to behave in certain circumstances. Schemas and scripts contain knowledge about an aspect of living, mental links to related attitudes, feelings and memories, and a repertoire of associated behaviours. Scripts additionally contain information about how commonly experienced situations “play out” (such as visiting a supermarket) and the typical sequence of behaviours in that situation (entrance at the left of the store, grab a trolley, milk at the back, bread in the second aisle, line up and pay). Schemas and scripts are activated by a trigger (for example, the supermarket logo) and, once active, help to direct our behaviour, often without our being aware of it. Children start to develop schemas about the world as toddlers (and perhaps earlier) and these can sometimes be aggressive in nature. In relation to the development of aggressive knowledge structures and attitudes, there is considerable evidence that exposure to violent media (including violent video games): 73 The impACT of violenT video gAmes: An overview (a) increases attitudes approving of aggressive behaviour as a “normal” social response (Huesmann, 1998); (b) increases mental access to scripts for resolving conflict that involve aggressive behaviour and reduces access to conflict- solving scripts that are non-aggressive (Bushman & Anderson, 2002; Huesmann, 1998); (c) underpins the attitude that aggression is (1) exciting and (2) increases one’s social status (Groebel, 1998); (d) increases the belief that the world is a frightening place (Cantor, 2003; Donnerstein et al, 1994); (e) increases a hostile attributional bias whereby ambiguous but innocent behaviours by others are interpreted as deliberately hurtful (Anderson et al, 2010; Möller & Krahé, 2009); and (f) increases the likelihood of aggressive behaviour (Anderson et al, 2010). Regrettably, children are exposed to a lot of violent media. As noted in Chapter 1, by the age of 18, most US children will have seen many tens of thousands of murders and acts of violence on television alone. Heavy playing of violent video games that involve frequently killing of other people or creatures would add greatly to those figures, especially for murders. This means that for a lot of children, violent media influences may result in higher levels of aggressive schemas, fear about the wider world, hostile and anti-social attitudes, and scripts for behaving aggres- sively, than might otherwise occur without those influences. Fictitious violence versus real violence Recent brain imaging studies, in which children’s brain activation patterns are “photographed” by fMRI machines whilst they are expe- riencing violent media, have shown that even when children know the violence they are watching is fictitious or fantasy violence, their brains respond to the violence as if there was a real threat (Murray et al, 2006; see also Weber et al, 2006). In addition, long-term memory systems were activated, suggesting that this effect could endure beyond the initial exposure. This research suggests that fantasy media violence seems to have a similar impact on children as exposure to realistic media violence. The General Aggression Model The General Aggression Model (GAM: Anderson & Bushman 2002; DeWall, Anderson & Bushman, in press) provides a theoretically sound and helpful way of understanding how exposure to violent media can increase a person’s likelihood of being aggressive in both the short and long term (see Figures 4 and 5). The GAM is a model of what is happening psychologically during an episode of aggression. In essence the person brings their own readiness to aggress, through their gender, beliefs and attitudes about aggres- sion, personality and other stable factors. Each situation has cues and triggers for aggression, such as the presence of a weapon or an insult. When a person encounters an aggression-triggering situation, various relevant cognitions (memories, beliefs, attitudes, scripts for behaviour) are activated, along with feelings (such as fear and anger) and a level of physiological arousal. Higher levels of arousal make a dominant tendency to act more likely. Figure 4: The General Aggression Model 75 The impACT of violenT video gAmes: An overview As a result of these activated cognitions and feelings, and of the level of arousal, the person has an immediate response. If they are very aroused or if the situation requires immediate action, this will probably be the ultimate response. If the person has the time and cognitive capac- ity for a more considered response they will evaluate their options and are more likely to make a thought-through response. Either way, the eventual response, which may be aggressive, is enacted, elicits a social response and the episode is encoded into memory. Once in memory, it becomes part of the “person” and can then affect their responses to future situations. Although “person” characteristics are very important in deter- mining how an individual reacts in a specific situation, the research presented in this chapter reveals that most people, regardless of personal characteristics, are influenced by violent video games. It also reveals that violent video games provide many cues for aggressive behaviour, activate aggressive cognitions and feelings, and can increase levels of arousal. These internal processes can explain why there is also a robust link between violent video game playing and aggressive behaviour. Over the long term, exposure to the attitudes, ideas and scripts for behaviour in violent video games leads to stable knowledge structures, attitudes, biases in thinking, scripts for conflict resolution and action tendencies that include aggressive behaviour (see Figure 5). In turn, these increase the base level of aggressiveness in that person’s personal- ity and bring the person to an aggression-triggering type of situation with a higher predisposition to aggress. Between the two models, it is easy to see how playing a video game can lead to aggression in the short term, and how repeated playing can lead to higher levels of aggression in the long term. Conclusions and advice for parents and professionals working with children In this chapter we have detailed the evidence that video games can be used for a wide array of helpful purposes, but that there can be many negative consequences for playing violent games, especially when played excessively. This raises an important question: “How do we help children to benefit from video games but escape their negative impacts?” In Chapter 1 it was noted that the “you are what you eat” principle applies to the way media exposure affects the way the human neural network “wires up” as well as to food consumption. Using the food metaphor can be helpful for parents and professionals when it comes to advising children on how to use media in a beneficial way. Through 77 The impACT of violenT video gAmes: An overview school education many children are interested in healthy eating and this can be extended to maintaining a healthy media diet. For example, children could be told that, as with food, there are media that are good to consume regularly (in moderation), media that are for infrequent consumption and media that children should avoid. Helping a child to self-regulate what they watch and hear in the media can be very important to a child’s development in this media saturated world. This may involve: • educating children about media effects generally and about video game effects specifically, so that children can learn to make informed choices; • helping children to limit their time playing video games; • encouraging children to play pro-social and educational video games in preference to violent games; • keeping video game consoles in public areas and out of children’s bedrooms; and • playing video games with your children so that you are aware of their content and can knowledgeably discuss the implications of playing certain types of games and screen out potentially harmful ones. It is desirable for children to be able use video games for a range of educational and developmental objectives, but to have less exposure to the more harmful impacts. We hope that this chapter has helped to dispel some popular myths about the impact of violent video games on children and adolescents and has clarified for readers how positive outcomes might be achieved. A Tragic Postscript I see MW2 more as a part of my training-simulation than anything else … You can more or less completely simulate actual operations These were the chilling words with which Anders Behring Breivik referred to the computer game Modern Warfare 2 in a 1500-page mani- festo disseminated just hours before he was responsible for the deaths of 76 of his fellow Norwegians (Moses, 2011; Shah, 2011; Townsend & Tisdall, 2011). The 32-year-old male behind the now infamous bombing 78 growing up fAsT And furious of government buildings in Oslo and subsequent shooting massacre on Utoya island on 22 July 2011 made no secret of the fact that playing the violent video games Modern Warfare 2 and World of Warcraft aided him in preparing and executing his attacks. Breivik identified Modern Warfare 2 as helping him with “target practice” (Shah, 2011) and involvement with World of Warcraft as providing sufficient cover for his preparatory activities (Moses, 2011). As a result of the attacks, one of Norway’s biggest retailers, Coop Norway, issued a ban of indefinite duration on these and other violent video games that, at the time of publication, has yet to be lifted (Narcisse, 2011; Navarro, 2011). When considering the impact of violent video games, particularly in light of the Norway atrocities, it should also be noted that video games in which acts of violence are executed in first-person, immersive environments have long been recognised and used by the US military forces as effec- tive in both the training and recruitment of their members (Holguin, 2009; Robson, 2008). I know that violent video games can potentially have negative effects on children, but are there any positive psychological effects associated with video games?
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EVIDENCE:
Parents often ask about the effects of violent video games on their children and teenagers. In most cases, they note that their “common sense” instinct is that too much exposure to violent video games must have some sort of negative effect on their children, but that they have read in the media that “the jury is still out” on violent media effects or that there is no convincing evidence that violent video game playing is harmful. Confusion around this conflict will often prompt them then to ask: “what does the scientific evidence really say?” In this chapter we show that the common sense view is backed up by a substantial body of recent scientific findings. Helpful and pro-social video game content has great potential for enhancing the lives of children and adolescents, but exposure to anti-social and violent video game content increases the likelihood of a range of negative outcomes, with greater exposure increasing the risk. Video games have been around for nearly 50 years. Kirsch (2010) notes the first as being Spacewar (released in 1962), a game in which two spaceships battle to the death in space. Although the graphics were very simple compared to modern games, the theme of battling to the death is one that has endured through the ensuing five decades. According to the most recent comprehensive poll by the Kaiser Foundation, American children aged 8–18 play an average of eight hours of video games per week, an increase of over 400 per cent from 1999 (Rideout, Foehr & Roberts, 2010). Playing is heaviest in the 11–14 age group, with boys outplaying girls more than 2.5 hours to 1. A recent study suggests that around 99 per cent of American boys play video games, along with 94 per cent of girls (Lenhart et al, 2008). It is common for US children and adolescents to play more than 20 hours per week 56Chapter in W. Warburton & D. Braunstein (Eds.) Growing Up Fast and Furious: Reviewing the Impacts of Violent and Sexualised Media on Children, (pp. 56-84). Annandale, NSW, Australia: The Federation Press. and it is not uncommon for males to play 40 hours or more per week (Bailey, West & Anderson, 2010). On average, Australian 7–18-year-olds played somewhat less than their US counterparts in 2007 (4.7 hours per week: see ACMA, 2007), but this figure could have risen substantially in recent years if Australian children have followed the steep upward trend found in the latest US studies. The types of games vary, but content analyses by Dill and colleagues (2005) show that the majority of top selling video games and children’s favourite games contain violence, and often strong violence. More recently, Call of Duty: Modern Warfare 2 grossed ~$USD 550 million in the first five days of its 2009 release, at that time more than any other entertainment product in history (movies included). Next on the list in 2009 was Grant Theft Auto IV (GTA), with ~$USD 500 million in five days. Even more recently (a year is a long time in the video game world) Call of Duty: Black Ops grossed $USD 360 million in a single day, breaking all records (Ortutay, 2010). According to Wikipedia, the massive multiplayer online game (MMOG) World of Warcraft has more than 12 million online subscribers and thus currently grosses more than $USD 180 million per month (at $15 per month per player). GTA, which is rated M17+ in the United States and involves such activities as going on murderous rampages, having sex with prostitutes and then murdering them to retrieve the money paid, has been played by 56 per cent of United States children aged 8–18 (Rideout et al, 2010). Clearly, a large number of children and adolescents are exposed regularly to video games with high levels of violence and anti-social themes. This makes it important for parents, educators and professionals who work with children to have some knowledge of their effects. Before turning to the negative effects of violent video games however, it is important to stress that video games can have many helpful benefits. Here are just a few. Helpful effects of video games Pain management Kirsch (2010) notes that various media, including video games, can be used to distract and relax children during painful medical procedures. 57 The impACT of violenT video gAmes: An overview Coordination and spatial cognition A number of studies reveal that video games which require the place- ment of objects within a screen (such as Tetris) can enhance the spatial cognition abilities of players (that is, the ability to mentally arrange and rotate objects in three dimensions). Indeed, video game playing has been linked with a wide array of visual and spatial skills, primarily through practice effects (see Green & Bavelier, 2006; Okagaki & Frensch, 1994; see also Bailey et al, 2010, for a review). In one study by Gopher, Weil and Bareket (1994), the flight performance of Israeli Air Force cadets who had been trained on the Space Fortress II video game was compared with the performance of an untrained group. The trained cadets performed better in almost all aspects of flight performance and as a result the game was incorporated into the Israeli Air Force training program. Pro-social behaviour Although this area of study is still in its infancy, there is mounting evidence that video games which model and involve participants in pro- social, helping behaviours can lead to increases in pro-social behaviour in the short and long term. Most notably, Gentile et al (2009) found that elementary school students exposed to pro-social video games were more helpful than those exposed to violent or non-social video games. In a second longitudinal study of Japanese children in grades 5, 8 and 11, exposure to pro-social video games at the start of the study was linked with increased pro-social behaviour some months later, even when the baseline pro-social tendencies of children were statistically removed. In a final study of Singaporean secondary school students, the amount of pro-social video game play experienced was correlated with helping behaviour, cooperation, sharing and empathy. A study by Greitemeyer and Osswald (2009) found that pro-social video game playing led to a short-term reduction in the tendency to see the world as hostile and an immediate reduction in anti-social thoughts. Education A considerable literature reveals video games to be a powerful teaching tool (eg, Barlett et al, 2009; Murphy et al, 2002; Swing & Anderson, 58 growing up fAsT And furious 2008). They have been used to teach algebra (Corbett et al, 2001), biol- ogy (Ybarrondo, 1984), photography (Abrams, 1986), and computer programming (Kahn, 1999), to teach children how to manage diabetes (Lieberman, 2001; 2006) and to teach specific skills using simulators (for example, by Qantas pilots, NASA and the Air Force). Gentile and Gentile (2008) describe the educational advantages of using video games as teaching tools. These include the power of video games to engage children and to “encourage children to persevere in acquiring and mastering a number of skills, to navigate through complex problems and changing environments, and to experiment with different identities until success is achieved” (p 127). Exercise There has been a recent explosion in the popularity of video games that promote physical activity and exercise (that is, “Exergames”). Games such as Wii Sports Heart Rate; Wii Fit; Wii Play; Wii FitPlus; Dance, Dance Revolution and Just Dance seem to be part of a recent trend that has seen an increase in the availability and popularity of non-violent, helpful games. Clearly, video games have considerable potential to enhance the lives of children and adolescents. Unfortunately, excessive video game playing, especially of violent video games, has the potential to impact children in a number of negative ways. Harmful effects of video games Video game addiction In his moving biography, Unplugged: My Journey into the Dark World of Video Game Addiction, Ryan Van Cleave describes the way that a violent online game, World of Warcraft, dominated his life to such an extent that he was unable to function normally and was driven to the verge of suicide. Video game addiction is now taken so seriously by psychologists and psychiatrists that it was recently considered for inclusion in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) as a diagnosable psychiatric disorder and has been lodged in its appendix to encourage further research. It is clear that many children 59 The impACT of violenT video gAmes: An overview play video games at a “pathological” level that causes damage to family, social, school or psychological functioning (see Anderson et al, 2012). For example, it has been found that 8.5 per cent of 8–18-year-old US video game players do so at pathological levels (Gentile, 2009). Similar studies have found figures of 11.9 per cent in Europe (Grusser et al, 2007), 8.7 per cent in Singapore (Choo et al, 2010), 10.3 per cent in China (Peng & Li, 2009) and 4 per cent for 12–18-year-olds in Norway (Johansson & Götestam, 2004), with a further 15.5 per cent “at risk”. As will be seen in the ensuing sections, the amount that children play video games is very important. Those who play excessively are not only at risk of a number of negative outcomes, they are also much more likely to be playing violent games (see Krahé & Möller, 2004). Attention deficits There are some studies linking the amount of time children spend play- ing video games to attention deficits, impulsivity and hyperactivity (see Bailey et al, 2010; Swing et al, 2010). For example, Gentile (2009) found that adolescents who used video games at pathological levels were nearly three times more likely to be diagnosed with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder than adolescents who played at non-pathological levels. In a landmark paper, Swing and colleagues (2010) examined the effect of video game playing on atten- tion in elementary school children. They used a longitudinal study that statistically controlled for a range of other factors that could also lead to attention problems and found that amount of time spent playing video games predicted increases in teacher assessments of attention deficits in the children 13 months later. These results suggest that the children’s level of video game playing played a causal role in their subsequent loss of attentional capacity. Anderson et al (2012) believe that on theoretical grounds some video games should have less effect on attentional problems (for exam- ple, those that require controlled thought and planning) and that those which require constant reactive behaviours from players (a common feature of many violent first person shooting games for example) may be more problematic in terms of children developing attentional difficulties. 60 growing up fAsT And furious School performance It is well established that spending longer hours playing video games is linked with poorer school performance for both children and adoles- cents (Anderson et al, 2007; Chan & Rabinowitz, 2006; Chiu et al, 2004; Cordes & Miller, 2000; Gentile, 2009; Gentile et al, 2004; Sharif & Sargent, 2006). One explanation for this is a simple displacement of time – hours spent playing video games eats into time that would normally be spent studying and reading. For example, in a study of 1491 youth between 10 and 19, gamers spent 30 per cent less time reading and 34 per cent less time doing homework (Cummings & Vandewater, 2007). It is also possible, however, that children who perform more poorly at school are also more likely to “spend more time playing games, where they may feel a sense of mastery that eludes them at school” (Anderson et al, 2012). Of course, another possibility is the that excessive gaming creates attention deficits, which in turn can lead to poorer school performance. Increased aggression Should we be concerned about children and adolescents playing violent video games? Can this lead to aggressive behaviour? Over 98 per cent of paediatricians in the United States have considered these questions and believe that excessive violent media exposure has a negative effect on childhood aggression (Gentile et al, 2004). Similarly, there is a consen- sus amongst the vast majority of violent video game researchers that too much exposure to violent video games increases the likelihood of aggressive thoughts, feelings and behaviours, leads to desensitisation to violence and also leads to decreases in pro-social behaviours and empathy (Anderson et al, 2010; Huesmann, 2010). There are, however, a small number of researchers who dispute this evidence and it seems that the views of this small minority have had a large impact on public perceptions (Anderson & Gentile, 2008; Dill, 2009). In this section of the chapter we will broadly examine the arguments for this view and then review the scientific evidence that does find violent video game effects. In this way, we hope that readers can judge the evidence for themselves. 1. The first argument against violent video game effects is that there is little evidence linking the playing of violent video games to very violent behaviours (such as school shootings). To better understand 61 The impACT of violenT video gAmes: An overview this argument it is helpful to reflect on the difference between aggres- sion and violence. In essence, violence is aggressive behaviour that has extreme harm as its goal (Anderson & Bushman, 2002). Thus, all violence is aggression but not all aggression is violence. With this in mind we make four points. (a) Ethically it is not possible to use the most powerful methods – experi- mental manipulations – to test the causal link between violent video games and violence because we cannot rightfully incite people to cause extreme harm in a laboratory. There are, however, ways to test links with aggressive behaviour, which can be examined ethi- cally in a laboratory. It is disingenuous to suggest that because there are no experimental studies that randomly assign children to years of playing violent or nonviolent video games and then measure which group commits the most violent crimes, that therefore there are no established negative or anti-social effects. This is like saying that because there are no experimental studies on humans showing that cigarette smoking causes lung cancer, smoking is not a causal risk factor. The causal links between violent video game playing and physical aggression are, in our opinion, well established. (b) Cross-sectional (correlational) studies and longitudinal studies of violent video game effects have established significant links to violent behaviour. Several longitudinal studies in particular provide strong evidence that these are causal effects. (c) Aggressive behaviour, which can include bullying, hurting other people physically, hurting other people’s property or relationships and hurting people verbally, is a very important social phenomenon in its own right. Aggression does not have to escalate into violence to be harmful and destructive. (d) No aggression researchers claim that media violence is the sole or even the most important source of violent behaviour. The most common approach, and the one taken by the authors, is the “risk factor” approach. According to this approach, people can have vari- ous risk factors for aggression or violent behaviour (see Figure 1). These might include coming from a violent home, having a violent peer group, high levels of trait aggression, exposure to violent media and a number of other factors. The more risk factors that are present for a person, especially when they are present from a young age, the more likely that person is to be aggressive or violent. Strasburger (2009, p 203) notes that: The research on media violence and its relationship to real-life aggression is clear: young people learn their attitudes about violence at a very young age, and once learned, those attitudes are difficult to change (Anderson et al, 2003; Bushman & Huesmann, 2006). Conservative estimates are that media violence may be causing 10% of real-life violence – not the leading cause by any means, but an unhealthy chunk that we could do something about if we chose to (Strasburger et al, 2009; Comstock & Strasburger, 1990). We believe that Victor Strasburger is right. Many risk factors for aggression and violence are very hard to deal with as parents, as educators, as professionals and as policy-makers. Media violence, though, is one risk factor that can be controlled and about which action can be taken from the level of the individual home through to the level of State and federal governments. This makes the research on media violence effects particularly important. 2. Detractors of the view that playing violent video games increases the likelihood of aggressive behaviour also criticise the methodology of video game studies and of meta-analyses of these studies. It is to this important scientific evidence that we now turn. Figure 1: Some longitudinal factors for youth violence Adapted from US Department of Health and Human Services (2001), Bushman and Huesmann (2006) and Anderson et al (2010). 63 The impACT of violenT video gAmes: An overview What is a meta-analysis and what evidence do the meta-analyses provide? A meta-analysis is a statistical technique whereby scientific studies that test the same or a similar hypothesis (for example, that violent video game exposure compared to neutral video game exposure will result in increased aggression) and the same or a similar outcome (for example, aggressive behaviour) are combined to ascertain the strength (“effect size”) of the average finding. To date there have been a number of meta- analyses of the effect of violent video games on aggressive thoughts, feelings and behaviours. In particular, studies by Distinguished Professor Craig Anderson and Dr Chris Ferguson have received a lot of publicity in recent years and it is valuable to compare them. Dr Ferguson, a vocal critic of the research demonstrating a link between violent video game playing and aggression, along with video game industry representatives, claims that violent video game research is methodologically flawed and that mainstream media violence researchers selectively report biased findings. Dr Ferguson has also suggested that Professor Anderson’s meta-analyses have a “publication bias” that undermines their results. Dr Ferguson cites his own three meta-analyses that examine the question of whether violent video game playing increases subsequent aggression. These examined 24, 17 and 14 published papers, encompassing 25, 21 and 15 separate tests of the same hypothesis respectively (Ferguson 2007a, 2007b; Ferguson & Kilburn, 2009). In total, 4205 and 3602 participants were tested in the first two meta-analyses (the number cannot be determined for the most recent study but is assumed to be lower). Dr Ferguson found a positive relation- ship between violent video game exposure and aggressive behaviour, with effect sizes of .29, .14 and .15 respectively. He then inappropriately (according to some meta-analysis experts, see Bushman, Rothstein, & Anderson, 2010) “corrected” for publication bias using a controversial statistical procedure called “trim and fill” that reduced these effect sizes. Such a procedure guesses what unpublished studies might be out there and adds these guesses to the averaging procedure. Based on the “corrected” figures, Dr Ferguson concluded there was no effect of violent video games on aggressive behaviour. These three meta-analyses, which use highly overlapping subsets of the same small sample of studies, are 64 growing up fAsT And furious widely cited as the strongest evidence that violent video game playing does not increase the likelihood of aggressive behaviour. Evidence that playing violent video games does increase the likeli- hood of aggression comes from many researchers. Professor Anderson and his colleagues have themselves conducted a large number of such studies and have also summarised the available studies in three compre- hensive meta-analyses, the first in 2001 (Anderson & Bushman, 2001), the second in 2004 (Anderson et al, 2004) and the most recent in 2010 (Anderson et al, 2010). The latter paper was co-authored by Professor Hannah Rothstein, an expert in meta-analyses and publication bias. This paper detailed major shortcomings in the Ferguson meta-analyses (which failed to include numerous relevant studies) and included all relevant studies then known. Data from 136 articles, 381 separate tests of hypotheses, and across a massive sample of 130, 296 participants were analysed. In this large, all-inclusive meta-analysis, research methodology was also examined. Among the many findings was that studies with better research methods tended to find stronger effects of violent video game playing on aggressive behaviour. We present a summary of the findings in Figure 2 (over page). We understand that the concept of effect size is a hard one to grasp without a detailed knowledge of statistical procedures, so we will provide some comparison data afterwards to help readers make sense of the results. The middle bar shows the effect found, the bars on either side reflect how variable the findings were in the studies tested. Figure 2 shows several meta-analyses. Each tests a different hypoth- esis. All hypotheses are tested as outcomes of exposure to violent video games, and these outcomes include aggressive behaviour, aggressive thoughts (cognitions), aggressive feelings (affects), physiological arousal, desensitisation to violence/low empathy and pro-social behaviour. As can be seen, the average effect across these many studies was one whereby exposure to violent video games led to an increase in aggressive behaviours, aggressive thoughts, aggressive feelings and physiological arousal (which is linked to aggressive behaviour), to desensitisation to violence and decreased empathy, and to a reduction in pro-social behaviours. It is important to note that these findings come from a range of study types – experimental studies in which all participants have exactly the same experience other than the media type they experi- ence, correlational studies of the links between levels of violent video game playing and various types of aggressive behaviours in real life, and longitudinal studies that follow video game playing patterns and behavioural patterns in the same people over time. Each study type makes a unique contribution to what we know. Experiments can be used to infer that one thing causes another, but it is harder to generalise these findings to “real life”. Correlational studies involve “real life” behaviours and can test alternative hypotheses, but it is difficult to determine the causal direction of relationships found (that is, whether playing violent games causes aggression or whether aggressive people choose violent games). Longitudinal studies are real world studies and can be used to find whether one thing causes another over time in a person’s life. Some media violence studies have followed the same people for over 40 years (eg, Huesmann et al, 2003) and have very detailed data. Because links between violent video game playing and aggression are found consistently across all three study types, the evidence converges to suggest both a causal link and an effect that is found in the real world. The Anderson et al (2010) meta-analysis also found that when proper statistical methods are used, there was no evidence of systematic publication bias in the studies. The rather weak evidence of publication bias produced by Dr Ferguson was likely the result of several factors, including failure to use all of the relevant studies and the combining of cross-sectional and experimental studies in the publication bias analysis. To understand how strong the obtained violent video game effect on aggression is, it can be helpful to get a sense of what the “effect size” numbers actually mean. It is easy to understand that a higher number means a stronger effect, but it is much harder to know how a big a number needs to be before it is considered important. Figure 3 shows some effect sizes for well known phenomena that can be used as points for comparison. As can be seen from Figure 3, violent video game effects are larger than the effect of eating calcium on bone mass, of asbestos inhalation Figure 3: The comparative effect sizes of violent video game effects and other well known phenomena * From Best Practices studies, Anderson et al, Psychological Bulletin, 2010. 67 The impACT of violenT video gAmes: An overview on related cancers, of condom use on reducing HIV infection numbers, of taking aspirin on reducing heart attacks and a range of other very important phenomena. Clearly, the size of violent video game effects is large enough to be considered socially important. A final finding from the Anderson et al (2010) meta-analyses is that the violent video game effects occurred for both males and females, and across low-violence collectivistic Eastern countries (for example, Japan) and high-violence individualistic Western countries (for example, Australia and the United States). This is not a surprising finding, as other reviews have found that violent video games affect people regardless of age, gender, socio-economic status, game genre and game system (Barlett et al, 2009). In fact, to the knowledge of the authors, no group has yet been identified that are immune to the effects of exposure to violent media such as video games (see Anderson et al, 2003). Perhaps the best brief summary of the evidence presented here is articulated in a statement produced by 13 researchers into violent video game effects (including the authors of this chapter), prepared for an amicus curiae (friend of the court) brief for the Schwarzenegger and Brown v Video Software Dealers Association and Entertainment Software Association case in the Supreme Court of the United States (Docket # 08-1448). This statement was supported as being accurate by a further 102 well-respected researchers in this area. Statement on Video Game Violence Both the American Psychological Association (APA, 2005) and the American Academy of Pediatrics (AAP, 2009) have issued formal statements stating that scientific research on violent video games clearly shows that such games are causally related to later aggressive behavior in children and adolescents. Extensive research has been conducted over many years using all three major types of research designs (experimental, cross-sectional, and longitudinal). Numerous original empirical research studies have been conducted on children and adolescents. Overall, the research data conclude that exposure to violent video games causes an increase in the likelihood of aggres- sive behavior. The effects are both immediate and long term. Violent video games have measurable and statistically significant effects on both males and females. Theoretically important effects of violent video games have been confirmed by many empirical studies. The effects have been replicated by researchers in different settings and in numerous countries. The psychological processes underlying 68 growing up fAsT And furious such effects are well understood and include: imitation, observa- tional learning, priming of cognitive, emotional and behavioral scripts, physiological arousal, and emotional desensitization. These are general processes that underlie all types of social behavior, not just aggression and violence; they have been confirmed by count- less studies outside of the media violence domain. In addition to causing an increase in the likelihood of aggressive behavior, violent video games have also been found to increase aggressive thinking, aggressive feelings, physiological desensitization to violence, and to decrease pro-social behavior. Importantly, this statement alludes to the psychological processes that are known to underlie the effect of exposure to violent video games on children. These are worth examining in more detail because they also provide some insight as to why the effects of violent video games, compared to other violent media, may be stronger. The psychology of violent video game effects on children Most of the explanations related to violent video game effects involve different types of learning. Because of certain features of violent video game playing – interactivity, repetition and the actual playing of the role of aggressor – the effects may be stronger and patterns of behaviour better learned. Imitation Humans seem to be hard-wired from birth to imitate others. Recently discovered “mirror neurons” in humans and primates represent one mechanism in the brain that may facilitate this (Caggiano et al, 2009; Gallese et al, 1996; Rizzolati et al, 1996; Umilta et al, 2001). Imitation has benefits, including the fast learning of important behaviours, and plays a role in human bonding. However, imitation of unhelpful and anti-social behaviours can have clear negative effects for the individual and for society. We know that children will imitate aggressive behaviours, even if the behaviours are totally new to the child and are not seen to be rewarded in any way (Bandura, 1965; 1973; Bandura et al, 1961; 1963a, 1963b). We also know that children imitate characters from the media they see, with some characters more likely to be imitated than others – those that are attractive, heroic, rewarded for their behaviour or liked, or that have high social status. In violent video games the central characters 69 The impACT of violenT video gAmes: An overview often meet several of these criteria. Does this mean, though, that people will copy the behaviours of the characters in very violent games such as GTA and others? It is possible. For example, an 18-year-old youth in Thailand stabbed a taxi driver to death trying to “find out if it was as easy in real life to rob a taxi as it was in the game” (Reed, 2008). As a result, GTA IV was banned in Thailand. In 2003 William Buckner, 16, and his step-brother Joshua, 14, killed a man and seriously wounded a woman shooting at cars in Tennessee (Calvert, 2003). The boys claimed they were acting out the game Grand Theft Auto III. Also in 2003, Devin Moore, an 18-year-old from Alabama, killed three police officers follow- ing his arrest for a carjacking. On being re-arrested he is reported to have told police that “Life is like a video game. Everybody’s got to die sometime” (Leung, 2005). Again, the killer told police he was copy- ing behaviour he had learned playing GTA III. We are not suggesting that violent video game playing alone was causal in these crimes. As noted earlier, numerous risk factors influence the likelihood of aggressive and violent b ehaviour, and the most severe forms of violence virtually always require the convergence of many risk factors. Furthermore, it is difficult (perhaps impossible) to identify which risk factors were crucial to any particular aggressive or violent act. Nonetheless, imitation of media violence seems to have played some role in these cases. There are numerous other stories of aggressive behaviours that seemingly imitate violent video games. These are easily accessed on the internet with a simple search. Clearly, for some violent video game players, simple imitation may play a causal role in some acts of aggression. However there are a number of other factors, also linked with imitation and learned aggression, that may also be important. Identification Although media effects can occur without the person identifying with any of the characters they have seen, identifying with an aggressor has been shown to increase the likelihood of adopting aggressive behav- iours and attitudes (Cantor, 1994; Huesmann & Eron, 1986; Huesmann et al, 2003). People are more likely to identify with a character who is perceived as similar, heroic and attractive (Hearold, 1986; Heath et al, 1989), and are more likely to identify with and believe realistic portray- als because they are easier to relate to personal experiences (Berkowitz 70 growing up fAsT And furious & Alioto, 1973; Feshback, 1972; Geen, 1975). In violent video games, the player strongly identifies with (and usually takes the role of) the aggres- sor. The aggressive central character is usually glorified and portrayed as heroic and, in recent years, the portrayal of aggressive characters in video games has become increasingly realistic (Gentile et al, 2007). For these reasons, identification with violent/aggressive characters may be a key way that video games impact on children. Repetition It is well established that repetition of behaviours establishes them in memory, increases skill and automates them as learned responses (eg, Gentile & Gentile, 2008). Further, repeating an entire behavioural sequence commits it to memory better than repeating only part of a sequence (Gentile et al, 2007). Violent video games are much more repetitive than other forms of violent media and more often involve the repetition of complete behavioural sequences (Gentile et al, 2007). Players repeat the same behaviours and receive similar rewards throughout the game, experience similar thoughts and feelings during those actions and are exposed to the attitudes espoused in the game implicitly and explicitly (for example, sleeping with prostitutes and then murdering them to retrieve one’s money in GTA implies misogyny, the acceptance of violence to get what one wants and that human life has little value). Simply put, the repetitive nature of violent video games is ideal for learning aggressive attitudes and scripts for behaviour. Interactivity Active participation assists learning as it requires attention, and closely attending to a task assists people to memorise the relevant behaviours and knowledge (Gentile et al, 2007; Gentile & Gentile, 2008). Violent video games are highly interactive, and the recent development of home consoles that allow players to use realistic weapons such as replica guns and swords further increases the level of interactivity and decreases the gap between game playing behaviours and “real world” behaviours. The combination of interactivity and frequent rehearsal is a potent one for learning. In essence, this is a key reason that video games are such powerful tools for teaching pilots, astronauts and soldiers their core skills. These factors give video games tremendous potential for 71 The impACT of violenT video gAmes: An overview pro-social pursuits and as learning tools, but have less welcome implica- tions regarding the interactive rehearsal of anti-social and aggressive behaviours. Lack of negative consequences Another basic tenet of learning theory, demonstrated across thousands of studies, is that people are more likely to behave in ways that are rewarded and less likely to behave in ways that are punished. In terms of imitation, children imitate aggression they perceive as being rewarded more often than aggression they perceive as resulting in punishment. Interestingly, children will imitate unpunished aggression as often as rewarded aggression (eg, see Bandura, 1973). With these facts in mind, it is relevant that most acts of violence in video games: (a) go unpunished; (b) are rewarded (for example, by points, money, status and eleva- tion to higher game levels); (c) have unrealistic consequences for the victim. With relation to the final point, it is important for parents and profession- als to note that seeing victims suffer realistic and negative consequences as a result of media violence should reduce the likelihood of subsequent aggression because pain cues usually inhibit aggressive behaviour (Baron, 1971a, 1971b, 1979). Also note, however, that in some circum- stances pain and suffering cues can increase aggressive behaviour (see Berkowitz, 1993, p 174). Associative learning As noted in Chapter 1, the brain is a neural network in which concepts, ideas, feelings and memories are stored and interconnected. The way this network “wires up” depends on what people experience, with paired experiences (such as the smell of fresh coffee, pleasure and a craving for a hot beverage) becoming more strongly wired together the more they are experienced together. This means that people learn to associate one thing with another. In media generally, and in violent video games especially, many things are frequently paired and thus become “wired” together. For 72 growing up fAsT And furious example, guns are rarely used for any purpose other than violent action. This is why there is a well demonstrated “weapons effect”, whereby the simple sight of a weapon increases the likelihood of aggression if the person has mentally paired a weapon such as a gun with killing or hurting people rather than with a non-aggressive use such as sports shooting (Bartholow et al, 2005; Berkowitz & LePage, 1967; Carlson et al, 1990). This suggests that children who often play video games where there is frequent weapon use for the purpose of killing and hurting others are more likely to be aggressive immediately after playing the game and are more likely to be aggressive when exposed to a weapon of a similar type in real life. Associative learning also explains why whole sequences of behav- iour are learned during video game play and why the acquisition of aggression-related knowledge structures is so important. Acquisition of aggressive knowledge structures, attitudes and scripts for behaviour Clearly, violent video games are powerful teachers, but what is the outcome of such learning for the individual child? In essence, the child (and adult for that matter) internalises clusters of associated knowledge about aggressive behaviour (knowledge structures or “schemas”), as well as attitudes about aggressive behaviour and “scripts” for how to behave in certain circumstances. Schemas and scripts contain knowledge about an aspect of living, mental links to related attitudes, feelings and memories, and a repertoire of associated behaviours. Scripts additionally contain information about how commonly experienced situations “play out” (such as visiting a supermarket) and the typical sequence of behaviours in that situation (entrance at the left of the store, grab a trolley, milk at the back, bread in the second aisle, line up and pay). Schemas and scripts are activated by a trigger (for example, the supermarket logo) and, once active, help to direct our behaviour, often without our being aware of it. Children start to develop schemas about the world as toddlers (and perhaps earlier) and these can sometimes be aggressive in nature. In relation to the development of aggressive knowledge structures and attitudes, there is considerable evidence that exposure to violent media (including violent video games): 73 The impACT of violenT video gAmes: An overview (a) increases attitudes approving of aggressive behaviour as a “normal” social response (Huesmann, 1998); (b) increases mental access to scripts for resolving conflict that involve aggressive behaviour and reduces access to conflict- solving scripts that are non-aggressive (Bushman & Anderson, 2002; Huesmann, 1998); (c) underpins the attitude that aggression is (1) exciting and (2) increases one’s social status (Groebel, 1998); (d) increases the belief that the world is a frightening place (Cantor, 2003; Donnerstein et al, 1994); (e) increases a hostile attributional bias whereby ambiguous but innocent behaviours by others are interpreted as deliberately hurtful (Anderson et al, 2010; Möller & Krahé, 2009); and (f) increases the likelihood of aggressive behaviour (Anderson et al, 2010). Regrettably, children are exposed to a lot of violent media. As noted in Chapter 1, by the age of 18, most US children will have seen many tens of thousands of murders and acts of violence on television alone. Heavy playing of violent video games that involve frequently killing of other people or creatures would add greatly to those figures, especially for murders. This means that for a lot of children, violent media influences may result in higher levels of aggressive schemas, fear about the wider world, hostile and anti-social attitudes, and scripts for behaving aggres- sively, than might otherwise occur without those influences. Fictitious violence versus real violence Recent brain imaging studies, in which children’s brain activation patterns are “photographed” by fMRI machines whilst they are expe- riencing violent media, have shown that even when children know the violence they are watching is fictitious or fantasy violence, their brains respond to the violence as if there was a real threat (Murray et al, 2006; see also Weber et al, 2006). In addition, long-term memory systems were activated, suggesting that this effect could endure beyond the initial exposure. This research suggests that fantasy media violence seems to have a similar impact on children as exposure to realistic media violence. The General Aggression Model The General Aggression Model (GAM: Anderson & Bushman 2002; DeWall, Anderson & Bushman, in press) provides a theoretically sound and helpful way of understanding how exposure to violent media can increase a person’s likelihood of being aggressive in both the short and long term (see Figures 4 and 5). The GAM is a model of what is happening psychologically during an episode of aggression. In essence the person brings their own readiness to aggress, through their gender, beliefs and attitudes about aggres- sion, personality and other stable factors. Each situation has cues and triggers for aggression, such as the presence of a weapon or an insult. When a person encounters an aggression-triggering situation, various relevant cognitions (memories, beliefs, attitudes, scripts for behaviour) are activated, along with feelings (such as fear and anger) and a level of physiological arousal. Higher levels of arousal make a dominant tendency to act more likely. Figure 4: The General Aggression Model 75 The impACT of violenT video gAmes: An overview As a result of these activated cognitions and feelings, and of the level of arousal, the person has an immediate response. If they are very aroused or if the situation requires immediate action, this will probably be the ultimate response. If the person has the time and cognitive capac- ity for a more considered response they will evaluate their options and are more likely to make a thought-through response. Either way, the eventual response, which may be aggressive, is enacted, elicits a social response and the episode is encoded into memory. Once in memory, it becomes part of the “person” and can then affect their responses to future situations. Although “person” characteristics are very important in deter- mining how an individual reacts in a specific situation, the research presented in this chapter reveals that most people, regardless of personal characteristics, are influenced by violent video games. It also reveals that violent video games provide many cues for aggressive behaviour, activate aggressive cognitions and feelings, and can increase levels of arousal. These internal processes can explain why there is also a robust link between violent video game playing and aggressive behaviour. Over the long term, exposure to the attitudes, ideas and scripts for behaviour in violent video games leads to stable knowledge structures, attitudes, biases in thinking, scripts for conflict resolution and action tendencies that include aggressive behaviour (see Figure 5). In turn, these increase the base level of aggressiveness in that person’s personal- ity and bring the person to an aggression-triggering type of situation with a higher predisposition to aggress. Between the two models, it is easy to see how playing a video game can lead to aggression in the short term, and how repeated playing can lead to higher levels of aggression in the long term. Conclusions and advice for parents and professionals working with children In this chapter we have detailed the evidence that video games can be used for a wide array of helpful purposes, but that there can be many negative consequences for playing violent games, especially when played excessively. This raises an important question: “How do we help children to benefit from video games but escape their negative impacts?” In Chapter 1 it was noted that the “you are what you eat” principle applies to the way media exposure affects the way the human neural network “wires up” as well as to food consumption. Using the food metaphor can be helpful for parents and professionals when it comes to advising children on how to use media in a beneficial way. Through 77 The impACT of violenT video gAmes: An overview school education many children are interested in healthy eating and this can be extended to maintaining a healthy media diet. For example, children could be told that, as with food, there are media that are good to consume regularly (in moderation), media that are for infrequent consumption and media that children should avoid. Helping a child to self-regulate what they watch and hear in the media can be very important to a child’s development in this media saturated world. This may involve: • educating children about media effects generally and about video game effects specifically, so that children can learn to make informed choices; • helping children to limit their time playing video games; • encouraging children to play pro-social and educational video games in preference to violent games; • keeping video game consoles in public areas and out of children’s bedrooms; and • playing video games with your children so that you are aware of their content and can knowledgeably discuss the implications of playing certain types of games and screen out potentially harmful ones. It is desirable for children to be able use video games for a range of educational and developmental objectives, but to have less exposure to the more harmful impacts. We hope that this chapter has helped to dispel some popular myths about the impact of violent video games on children and adolescents and has clarified for readers how positive outcomes might be achieved. A Tragic Postscript I see MW2 more as a part of my training-simulation than anything else … You can more or less completely simulate actual operations These were the chilling words with which Anders Behring Breivik referred to the computer game Modern Warfare 2 in a 1500-page mani- festo disseminated just hours before he was responsible for the deaths of 76 of his fellow Norwegians (Moses, 2011; Shah, 2011; Townsend & Tisdall, 2011). The 32-year-old male behind the now infamous bombing 78 growing up fAsT And furious of government buildings in Oslo and subsequent shooting massacre on Utoya island on 22 July 2011 made no secret of the fact that playing the violent video games Modern Warfare 2 and World of Warcraft aided him in preparing and executing his attacks. Breivik identified Modern Warfare 2 as helping him with “target practice” (Shah, 2011) and involvement with World of Warcraft as providing sufficient cover for his preparatory activities (Moses, 2011). As a result of the attacks, one of Norway’s biggest retailers, Coop Norway, issued a ban of indefinite duration on these and other violent video games that, at the time of publication, has yet to be lifted (Narcisse, 2011; Navarro, 2011). When considering the impact of violent video games, particularly in light of the Norway atrocities, it should also be noted that video games in which acts of violence are executed in first-person, immersive environments have long been recognised and used by the US military forces as effec- tive in both the training and recruitment of their members (Holguin, 2009; Robson, 2008).
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I know that violent video games can potentially have negative effects on children, but are there any positive psychological effects associated with video games?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
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I keep hearing about cryptocurrencies, and I would like to own some. I'm a customer at a local bank, and I was wondering how cryptocurrencies will change the future of banks. I would like my bank and cryptocurrency to be intertwined, as that gives me a sense of security.
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Although the world of cryptocurrency is steadily expanding and gaining popularity, traditional banks are hesitant to adopt the use of these digital assets—believing that their inherent risks outweigh their potential benefits. However, regulatory agencies such as the Office of the Comptroller of the Currency (OCC) are working to change banks’ perception of digital currencies, believing that these assets could positively drive financial institutions to a new era of innovation and efficiency. Recently, the OCC issued several interpretive letters detailing how traditional financial institutions can enter into transactions (or develop services) involving digital currencies. This effort coincides with the OCC’s hope that additional regulatory guidance will help banks become more comfortable with these digital assets. In early January, the OCC announced that national banks and federal savings associations can now use public blockchains and stablecoins to perform payment activities. This opens the door for banks to have the ability to process payments much quicker and without the need of a third-party agency. Essentially, this clarifying letter puts blockchain networks in the same category as SWIFT, ACH, and FedWire, paving the way for these networks to be part of the larger banking ecosystem. Banks may be wary of cryptocurrency, thinking that transactions involving these assets present heightened risk and require lengthy and expensive due diligence. But digital currencies can offer many benefits to financial institutions and their customers, they just need to take the leap. Why Banks are Cautious of Cryptocurrencies According to a study conducted by the Association of Certified Anti-Money Laundering Specialists (ACAMS) and the U.K.’s Royal United Services Institute, nearly 63% of respondents who work in the banking industry perceive cryptocurrency as a risk rather than an opportunity. Decentralized Nature Crypto assets were created as an alternative to traditional banking infrastructure that don’t need an intermediary and aren’t tethered to the capacity of a centralized government, bank, or agency. Instead of relying on centralized intermediaries in these transactions, the trust is placed in the blockchain code and the distributed nature of the blockchain. A cryptocurrency that’s managed by a central bank diminishes the appeal of the asset in the first place, so some banks don’t believe that they’ll be able to enter this space successfully. The decentralized nature of the currency is seen to undermine the authority of central banks, leaving some to believe that they won’t be needed anymore, or they’ll be unable to control the money supply. AML/KYC Concerns Cryptocurrencies allow for peer-to-peer transactions without a regulated intermediary, giving the user the ability to easily transfer funds quickly without having to pay transaction fees. Instead of identifying the transaction by an individual bank account through a financial institution, transactions are simply linked to the transaction ID on the blockchain. This type of pseudonymity worries many banks who are concerned about the lack of anti-money laundering (AML) and know your customer (KYC) regulations surrounding digital currency transactions. Oftentimes, banks are under the impression that cryptocurrency transactions can’t be tracked for AML and KYC considerations, which could lead to illegal activity and scams on the network. Volatility The price of cryptocurrencies (bitcoin specifically) have generally been volatile over their short life. There are many reasons for this including market size, liquidity, and the number of market participants. Banks see this as a risk because historically, the price hasn’t been stable, so they believe the currency might not remain a stable investment vehicle over time. How Banks Can Get Involved in the Cryptocurrency Industry To avoid being left behind, banks need to find a way to embrace this technology and treat it as a friend rather than an enemy. Cryptocurrency adoption could streamline, enhance, and upgrade financial services, and there are plenty of recent industry advancements that can ease banks’ concerns around the risks and instead let them recognize the potential benefits. Custody Services In July, the OCC stated that banks and savings associations could provide crypto custody services for customers, including holding unique cryptographic keys associated with accessing private wallets. This means that the OCC believes that banks could safely and effectively hold either the cryptocurrency itself, or the key to access crypto on a personal digital wallet for its customers. Easy Onboarding & Expert Assistance Banks could help bring new, less experienced individual investors into the space by developing tools that would facilitate the adoption of crypto by their customers. For example, inexperienced cryptocurrency investors may not have the capabilities to set up their own wallet to custody their own cryptocurrency. Rather than leaving their cryptocurrency “off exchange” or at an unregulated third party, they may find it easier and more secure to hold it within a trusted financial institution. Banks could offer interest-bearing crypto accounts, where customers could invest the crypto on the back end or through other financial tools. Banks might relieve some of the stress of investors that aren’t experts in the nuances of crypto by acting as a trusted third party that’s well-respected in the finance industry and can keep investors’ assets protected. AML/KYC Regulations Administered In 2019, the Financial Crimes Enforcement Network’s (FinCEN) determined that any cryptocurrency transactions and custody services conducted through crypto entities that are considered money service businesses must still abide by AML/KYC regulations. This will help avoid malicious transactions, illegal activity, or scams using these platforms. These regulations could help banks and larger financial institutions conduct due diligence on customers involved in crypto transactions, further diminishing their anxieties about the risks that these transactions pose. There’s even a possibility that blockchain technology could automate AML and KYC verifications. Blockchain could potentially allow for a streamlined view of shared data on individuals between banks, loan officers, and other institutions. In other words, there could eventually be one blockchain that stores all customer data. This blockchain data could then be utilized by all financial institutions, allowing for fast reviews of customers to quickly identify any red flags insinuating nefarious or illegal activity. Security Concerns Banks can help mitigate the security concerns of cryptocurrency holders. Hacking of personal wallets and exchanges is a concern for many holders. Well-established banks could help secure digital currencies from theft or hacks, putting clients’ minds at ease. Bringing cryptocurrency under bank supervision could help diminish criminal activity or the appearance to outsiders that cryptocurrency transactions aren’t secure. Payments As indicated in the most recent OCC letter, banks can utilize public blockchains, including stablecoins, to speed up their payment processes. Blockchain technology provides a faster and less expensive alternative to clearing houses when processing transactions. The clearing and settlements could occur at a much faster rate if banks utilized blockchain technology. Smart Contracts When entering into an agreement through a smart contract, there’s a reduced level of trust needed among parties because the success of the transaction relies on computer code instead of an individual’s behavior. Banks could reinforce that trust by becoming a reliable third party that utilizes these smart contracts for mortgages, commercial loans, letters of credit, or other transactions. Guidance and regulation surrounding digital assets is sparse, leaving many financial institutions wary of adoption. Concerns surrounding the security and stability of cryptocurrency also hold banks back from entering this space—but instead of fearing the risks of this technology, banks should be looking ahead to its potential benefits. Financial institutions should also shift from thinking of crypto as a competitor to that of a partner. Banks can actually play a significant role in the crypto industry, adding some much needed assurance and security to the largely unregulated environment. Adopting cryptocurrencies and blockchain technology overall can streamline processes and take banking into the next generation of efficiency and innovation.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> I keep hearing about cryptocurrencies, and I would like to own some. I'm a customer at a local bank, and I was wondering how cryptocurrencies will change the future of banks. I would like my bank and cryptocurrency to be intertwined, as that gives me a sense of security. <TEXT> Although the world of cryptocurrency is steadily expanding and gaining popularity, traditional banks are hesitant to adopt the use of these digital assets—believing that their inherent risks outweigh their potential benefits. However, regulatory agencies such as the Office of the Comptroller of the Currency (OCC) are working to change banks’ perception of digital currencies, believing that these assets could positively drive financial institutions to a new era of innovation and efficiency. Recently, the OCC issued several interpretive letters detailing how traditional financial institutions can enter into transactions (or develop services) involving digital currencies. This effort coincides with the OCC’s hope that additional regulatory guidance will help banks become more comfortable with these digital assets. In early January, the OCC announced that national banks and federal savings associations can now use public blockchains and stablecoins to perform payment activities. This opens the door for banks to have the ability to process payments much quicker and without the need of a third-party agency. Essentially, this clarifying letter puts blockchain networks in the same category as SWIFT, ACH, and FedWire, paving the way for these networks to be part of the larger banking ecosystem. Banks may be wary of cryptocurrency, thinking that transactions involving these assets present heightened risk and require lengthy and expensive due diligence. But digital currencies can offer many benefits to financial institutions and their customers, they just need to take the leap. Why Banks are Cautious of Cryptocurrencies According to a study conducted by the Association of Certified Anti-Money Laundering Specialists (ACAMS) and the U.K.’s Royal United Services Institute, nearly 63% of respondents who work in the banking industry perceive cryptocurrency as a risk rather than an opportunity. Decentralized Nature Crypto assets were created as an alternative to traditional banking infrastructure that don’t need an intermediary and aren’t tethered to the capacity of a centralized government, bank, or agency. Instead of relying on centralized intermediaries in these transactions, the trust is placed in the blockchain code and the distributed nature of the blockchain. A cryptocurrency that’s managed by a central bank diminishes the appeal of the asset in the first place, so some banks don’t believe that they’ll be able to enter this space successfully. The decentralized nature of the currency is seen to undermine the authority of central banks, leaving some to believe that they won’t be needed anymore, or they’ll be unable to control the money supply. AML/KYC Concerns Cryptocurrencies allow for peer-to-peer transactions without a regulated intermediary, giving the user the ability to easily transfer funds quickly without having to pay transaction fees. Instead of identifying the transaction by an individual bank account through a financial institution, transactions are simply linked to the transaction ID on the blockchain. This type of pseudonymity worries many banks who are concerned about the lack of anti-money laundering (AML) and know your customer (KYC) regulations surrounding digital currency transactions. Oftentimes, banks are under the impression that cryptocurrency transactions can’t be tracked for AML and KYC considerations, which could lead to illegal activity and scams on the network. Volatility The price of cryptocurrencies (bitcoin specifically) have generally been volatile over their short life. There are many reasons for this including market size, liquidity, and the number of market participants. Banks see this as a risk because historically, the price hasn’t been stable, so they believe the currency might not remain a stable investment vehicle over time. How Banks Can Get Involved in the Cryptocurrency Industry To avoid being left behind, banks need to find a way to embrace this technology and treat it as a friend rather than an enemy. Cryptocurrency adoption could streamline, enhance, and upgrade financial services, and there are plenty of recent industry advancements that can ease banks’ concerns around the risks and instead let them recognize the potential benefits. Custody Services In July, the OCC stated that banks and savings associations could provide crypto custody services for customers, including holding unique cryptographic keys associated with accessing private wallets. This means that the OCC believes that banks could safely and effectively hold either the cryptocurrency itself, or the key to access crypto on a personal digital wallet for its customers. Easy Onboarding & Expert Assistance Banks could help bring new, less experienced individual investors into the space by developing tools that would facilitate the adoption of crypto by their customers. For example, inexperienced cryptocurrency investors may not have the capabilities to set up their own wallet to custody their own cryptocurrency. Rather than leaving their cryptocurrency “off exchange” or at an unregulated third party, they may find it easier and more secure to hold it within a trusted financial institution. Banks could offer interest-bearing crypto accounts, where customers could invest the crypto on the back end or through other financial tools. Banks might relieve some of the stress of investors that aren’t experts in the nuances of crypto by acting as a trusted third party that’s well-respected in the finance industry and can keep investors’ assets protected. AML/KYC Regulations Administered In 2019, the Financial Crimes Enforcement Network’s (FinCEN) determined that any cryptocurrency transactions and custody services conducted through crypto entities that are considered money service businesses must still abide by AML/KYC regulations. This will help avoid malicious transactions, illegal activity, or scams using these platforms. These regulations could help banks and larger financial institutions conduct due diligence on customers involved in crypto transactions, further diminishing their anxieties about the risks that these transactions pose. There’s even a possibility that blockchain technology could automate AML and KYC verifications. Blockchain could potentially allow for a streamlined view of shared data on individuals between banks, loan officers, and other institutions. In other words, there could eventually be one blockchain that stores all customer data. This blockchain data could then be utilized by all financial institutions, allowing for fast reviews of customers to quickly identify any red flags insinuating nefarious or illegal activity. Security Concerns Banks can help mitigate the security concerns of cryptocurrency holders. Hacking of personal wallets and exchanges is a concern for many holders. Well-established banks could help secure digital currencies from theft or hacks, putting clients’ minds at ease. Bringing cryptocurrency under bank supervision could help diminish criminal activity or the appearance to outsiders that cryptocurrency transactions aren’t secure. Payments As indicated in the most recent OCC letter, banks can utilize public blockchains, including stablecoins, to speed up their payment processes. Blockchain technology provides a faster and less expensive alternative to clearing houses when processing transactions. The clearing and settlements could occur at a much faster rate if banks utilized blockchain technology. Smart Contracts When entering into an agreement through a smart contract, there’s a reduced level of trust needed among parties because the success of the transaction relies on computer code instead of an individual’s behavior. Banks could reinforce that trust by becoming a reliable third party that utilizes these smart contracts for mortgages, commercial loans, letters of credit, or other transactions. Guidance and regulation surrounding digital assets is sparse, leaving many financial institutions wary of adoption. Concerns surrounding the security and stability of cryptocurrency also hold banks back from entering this space—but instead of fearing the risks of this technology, banks should be looking ahead to its potential benefits. Financial institutions should also shift from thinking of crypto as a competitor to that of a partner. Banks can actually play a significant role in the crypto industry, adding some much needed assurance and security to the largely unregulated environment. Adopting cryptocurrencies and blockchain technology overall can streamline processes and take banking into the next generation of efficiency and innovation. https://www.wolfandco.com/resources/insights/how-cryptocurrencies-may-impact-the-banking-industry/
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
Although the world of cryptocurrency is steadily expanding and gaining popularity, traditional banks are hesitant to adopt the use of these digital assets—believing that their inherent risks outweigh their potential benefits. However, regulatory agencies such as the Office of the Comptroller of the Currency (OCC) are working to change banks’ perception of digital currencies, believing that these assets could positively drive financial institutions to a new era of innovation and efficiency. Recently, the OCC issued several interpretive letters detailing how traditional financial institutions can enter into transactions (or develop services) involving digital currencies. This effort coincides with the OCC’s hope that additional regulatory guidance will help banks become more comfortable with these digital assets. In early January, the OCC announced that national banks and federal savings associations can now use public blockchains and stablecoins to perform payment activities. This opens the door for banks to have the ability to process payments much quicker and without the need of a third-party agency. Essentially, this clarifying letter puts blockchain networks in the same category as SWIFT, ACH, and FedWire, paving the way for these networks to be part of the larger banking ecosystem. Banks may be wary of cryptocurrency, thinking that transactions involving these assets present heightened risk and require lengthy and expensive due diligence. But digital currencies can offer many benefits to financial institutions and their customers, they just need to take the leap. Why Banks are Cautious of Cryptocurrencies According to a study conducted by the Association of Certified Anti-Money Laundering Specialists (ACAMS) and the U.K.’s Royal United Services Institute, nearly 63% of respondents who work in the banking industry perceive cryptocurrency as a risk rather than an opportunity. Decentralized Nature Crypto assets were created as an alternative to traditional banking infrastructure that don’t need an intermediary and aren’t tethered to the capacity of a centralized government, bank, or agency. Instead of relying on centralized intermediaries in these transactions, the trust is placed in the blockchain code and the distributed nature of the blockchain. A cryptocurrency that’s managed by a central bank diminishes the appeal of the asset in the first place, so some banks don’t believe that they’ll be able to enter this space successfully. The decentralized nature of the currency is seen to undermine the authority of central banks, leaving some to believe that they won’t be needed anymore, or they’ll be unable to control the money supply. AML/KYC Concerns Cryptocurrencies allow for peer-to-peer transactions without a regulated intermediary, giving the user the ability to easily transfer funds quickly without having to pay transaction fees. Instead of identifying the transaction by an individual bank account through a financial institution, transactions are simply linked to the transaction ID on the blockchain. This type of pseudonymity worries many banks who are concerned about the lack of anti-money laundering (AML) and know your customer (KYC) regulations surrounding digital currency transactions. Oftentimes, banks are under the impression that cryptocurrency transactions can’t be tracked for AML and KYC considerations, which could lead to illegal activity and scams on the network. Volatility The price of cryptocurrencies (bitcoin specifically) have generally been volatile over their short life. There are many reasons for this including market size, liquidity, and the number of market participants. Banks see this as a risk because historically, the price hasn’t been stable, so they believe the currency might not remain a stable investment vehicle over time. How Banks Can Get Involved in the Cryptocurrency Industry To avoid being left behind, banks need to find a way to embrace this technology and treat it as a friend rather than an enemy. Cryptocurrency adoption could streamline, enhance, and upgrade financial services, and there are plenty of recent industry advancements that can ease banks’ concerns around the risks and instead let them recognize the potential benefits. Custody Services In July, the OCC stated that banks and savings associations could provide crypto custody services for customers, including holding unique cryptographic keys associated with accessing private wallets. This means that the OCC believes that banks could safely and effectively hold either the cryptocurrency itself, or the key to access crypto on a personal digital wallet for its customers. Easy Onboarding & Expert Assistance Banks could help bring new, less experienced individual investors into the space by developing tools that would facilitate the adoption of crypto by their customers. For example, inexperienced cryptocurrency investors may not have the capabilities to set up their own wallet to custody their own cryptocurrency. Rather than leaving their cryptocurrency “off exchange” or at an unregulated third party, they may find it easier and more secure to hold it within a trusted financial institution. Banks could offer interest-bearing crypto accounts, where customers could invest the crypto on the back end or through other financial tools. Banks might relieve some of the stress of investors that aren’t experts in the nuances of crypto by acting as a trusted third party that’s well-respected in the finance industry and can keep investors’ assets protected. AML/KYC Regulations Administered In 2019, the Financial Crimes Enforcement Network’s (FinCEN) determined that any cryptocurrency transactions and custody services conducted through crypto entities that are considered money service businesses must still abide by AML/KYC regulations. This will help avoid malicious transactions, illegal activity, or scams using these platforms. These regulations could help banks and larger financial institutions conduct due diligence on customers involved in crypto transactions, further diminishing their anxieties about the risks that these transactions pose. There’s even a possibility that blockchain technology could automate AML and KYC verifications. Blockchain could potentially allow for a streamlined view of shared data on individuals between banks, loan officers, and other institutions. In other words, there could eventually be one blockchain that stores all customer data. This blockchain data could then be utilized by all financial institutions, allowing for fast reviews of customers to quickly identify any red flags insinuating nefarious or illegal activity. Security Concerns Banks can help mitigate the security concerns of cryptocurrency holders. Hacking of personal wallets and exchanges is a concern for many holders. Well-established banks could help secure digital currencies from theft or hacks, putting clients’ minds at ease. Bringing cryptocurrency under bank supervision could help diminish criminal activity or the appearance to outsiders that cryptocurrency transactions aren’t secure. Payments As indicated in the most recent OCC letter, banks can utilize public blockchains, including stablecoins, to speed up their payment processes. Blockchain technology provides a faster and less expensive alternative to clearing houses when processing transactions. The clearing and settlements could occur at a much faster rate if banks utilized blockchain technology. Smart Contracts When entering into an agreement through a smart contract, there’s a reduced level of trust needed among parties because the success of the transaction relies on computer code instead of an individual’s behavior. Banks could reinforce that trust by becoming a reliable third party that utilizes these smart contracts for mortgages, commercial loans, letters of credit, or other transactions. Guidance and regulation surrounding digital assets is sparse, leaving many financial institutions wary of adoption. Concerns surrounding the security and stability of cryptocurrency also hold banks back from entering this space—but instead of fearing the risks of this technology, banks should be looking ahead to its potential benefits. Financial institutions should also shift from thinking of crypto as a competitor to that of a partner. Banks can actually play a significant role in the crypto industry, adding some much needed assurance and security to the largely unregulated environment. Adopting cryptocurrencies and blockchain technology overall can streamline processes and take banking into the next generation of efficiency and innovation.
USER:
I keep hearing about cryptocurrencies, and I would like to own some. I'm a customer at a local bank, and I was wondering how cryptocurrencies will change the future of banks. I would like my bank and cryptocurrency to be intertwined, as that gives me a sense of security.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 49 | 1,263 | null | 68 |
Refer only to the context document in your answer. Do not employ any outside information. Use complete sentences.
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Summarize the possible uses, that are addressed in the provided document, of Google Gemini.
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**What is Google Gemini (formerly Bard)?** Google Gemini -- formerly called Bard -- is an artificial intelligence (AI) chatbot tool designed by Google to simulate human conversations using natural language processing (NLP) and machine learning. In addition to supplementing Google Search, Gemini can be integrated into websites, messaging platforms or applications to provide realistic, natural language responses to user questions. List of tasks Google Gemini can perform. Google Gemini can be applied pragmatically to complete various tasks. Google Gemini is a family of multimodal AI large language models (LLMs) that have capabilities in language, audio, code and video understanding. Gemini 1.0 was announced on Dec. 6, 2023, and built by Alphabet's Google DeepMind business unit, which is focused on advanced AI research and development. Google co-founder Sergey Brin is credited with helping to develop the Gemini LLMs, alongside other Google staff. At its release, Gemini was the most advanced set of LLMs at Google, powering Bard before Bard's renaming and superseding the company's Pathways Language Model (Palm 2). As was the case with Palm 2, Gemini was integrated into multiple Google technologies to provide generative AI capabilities. Gemini integrates NLP capabilities, which provide the ability to understand and process language. Gemini is also used to comprehend input queries as well as data. It's able to understand and recognize images, enabling it to parse complex visuals, such as charts and figures, without the need for external optical character recognition (OCR). It also has broad multilingual capabilities for translation tasks and functionality across different languages. How does Google Gemini work? Google Gemini works by first being trained on a massive corpus of data. After training, the model uses several neural network techniques to be able to understand content, answer questions, generate text and produce outputs. Specifically, the Gemini LLMs use a transformer model-based neural network architecture. The Gemini architecture has been enhanced to process lengthy contextual sequences across different data types, including text, audio and video. Google DeepMind makes use of efficient attention mechanisms in the transformer decoder to help the models process long contexts, spanning different modalities. Gemini models have been trained on diverse multimodal and multilingual data sets of text, images, audio and video with Google DeepMind using advanced data filtering to optimize training. As different Gemini models are deployed in support of specific Google services, there's a process of targeted fine-tuning that can be used to further optimize a model for a use case. During both the training and inference phases, Gemini benefits from the use of Google's latest tensor processing unit chips, TPU v5, which are optimized custom AI accelerators designed to efficiently train and deploy large models. A key challenge for LLMs is the risk of bias and potentially toxic content. According to Google, Gemini underwent extensive safety testing and mitigation around risks such as bias and toxicity to help provide a degree of LLM safety. To help further ensure Gemini works as it should, the models were tested against academic benchmarks spanning language, image, audio, video and code domains. Google has assured the public it adheres to a list of AI principles. At launch on Dec. 6, 2023, Gemini was announced to be made up of a series of different model sizes, each designed for a specific set of use cases and deployment environments. The Ultra model is the top end and is designed for highly complex tasks. The Pro model is designed for performance and deployment at scale. As of Dec. 13, 2023, Google enabled access to Gemini Pro in Google Cloud Vertex AI and Google AI Studio. For code, a version of Gemini Pro is being used to power the Google AlphaCode 2 generative AI coding technology. The Nano model is targeted at on-device use cases. There are two different versions of Gemini Nano: Nano-1 is a 1.8 billion-parameter model, while Nano-2 is a 3.25 billion-parameter model. Among the places where Nano is being embedded is the Google Pixel 8 Pro smartphone. When was Google Bard first released? Google initially announced Bard, its AI-powered chatbot, on Feb. 6, 2023, with a vague release date. It opened access to Bard on March 21, 2023, inviting users to join a waitlist. On May 10, 2023, Google removed the waitlist and made Bard available in more than 180 countries and territories. Almost precisely a year after its initial announcement, Bard was renamed Gemini. Many believed that Google felt the pressure of ChatGPT's success and positive press, leading the company to rush Bard out before it was ready. For example, during a live demo by Google and Alphabet CEO Sundar Pichai, it responded to a query with a wrong answer. In the demo, a user asked Bard the question: "What new discoveries from the James Webb Space Telescope can I tell my 9-year-old about?" In Bard's response, it mentioned that the telescope "took the very first pictures of a planet outside of our own solar system." Astronomers quickly took to social media to point out that the first image of an exoplanet was taken by an earthbound observatory in 2004, making Bard's answer incorrect. The next day, Google lost $100 billion in market value -- a decline attributed to the embarrassing mistake. Why did Google rename Bard to Gemini and when did it happen? Bard was renamed Gemini on Feb. 8, 2024. Gemini was already the LLM powering Bard. Rebranding the platform as Gemini some believe might have been done to draw attention away from the Bard moniker and the criticism the chatbot faced when it was first released. It also simplified Google's AI effort and focused on the success of the Gemini LLM. The name change also made sense from a marketing perspective, as Google aims to expand its AI services. It's a way for Google to increase awareness of its advanced LLM offering as AI democratization and advancements show no signs of slowing. Who can use Google Gemini? Gemini is widely available around the world. Gemini Pro is available in more than 230 countries and territories, while Gemini Advanced is available in more than 150 countries at the time of this writing. However, there are age limits in place to comply with laws and regulations that exist to govern AI. Users must be at least 18 years old and have a personal Google account. However, age restrictions vary for the Gemini web app. Users in Europe must be 18 or older. In other countries where the platform is available, the minimum age is 13 unless otherwise specified by local laws. Also, users younger than 18 can only use the Gemini web app in English. Is Gemini free to use? When Bard became available, Google gave no indication that it would charge for use. Google has no history of charging customers for services, excluding enterprise-level usage of Google Cloud. The assumption was that the chatbot would be integrated into Google's basic search engine, and therefore be free to use. After rebranding Bard to Gemini on Feb. 8, 2024, Google introduced a paid tier in addition to the free web application. Pro and Nano currently are free to use via registration. However, users can only get access to Ultra through the Gemini Advanced option for $20 per month. Users sign up for Gemini Advanced through a Google One AI Premium subscription, which also includes Google Workspace features and 2 terabytes of storage. What can you use Gemini for? Use cases and applications The Google Gemini models are used in many different ways, including text, image, audio and video understanding. The multimodal nature of Gemini also enables these different types of input to be combined for generating output. Use cases Businesses can use Gemini to perform various tasks that include the following: Text summarization. Gemini models can summarize content from different types of data. Text generation. Gemini can generate text based on user prompts. That text can also be driven by a Q&A-type chatbot interface. Text translation. The Gemini models have broad multilingual capabilities, enabling translation and understanding of more than 100 languages. Image understanding. Gemini can parse complex visuals, such as charts, figures and diagrams, without external OCR tools. It can be used for image captioning and visual Q&A capabilities. Audio processing. Gemini has support for speech recognition across more than 100 languages and audio translation tasks. Video understanding. Gemini can process and understand video clip frames to answer questions and generate descriptions. Multimodal reasoning. A key strength of Gemini is its use of multimodal AI reasoning, where different types of data can be mixed for a prompt to generate an output. Code analysis and generation. Gemini can understand, explain and generate code in popular programming languages, including Python, Java, C++ and Go. Applications Google developed Gemini as a foundation model to be widely integrated across various Google services. It's also available for developers to use in building their own applications. Applications that use Gemini include the following: AlphaCode 2. Google DeepMind's AlphaCode 2 code generation tool makes use of a customized version of Gemini Pro. Google Pixel. The Google-built Pixel 8 Pro smartphone is the first device engineered to run Gemini Nano. Gemini powers new features in existing Google apps, such as summarization in Recorder and Smart Reply in Gboard for messaging apps. Android 14. The Pixel 8 Pro is the first Android smartphone to benefit from Gemini. Android developers can build with Gemini Nano through the AICore system capability. Vertex AI. Google Cloud's Vertex AI service, which provides foundation models that developers can use to build applications, also provides access to Gemini Pro. Google AI Studio. Developers can build prototypes and apps with Gemini via the Google AI Studio web-based tool. Search. Google is experimenting with using Gemini in its Search Generative Experience to reduce latency and improve quality.
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{Question} Summarize the possible uses, that are addressed in the provided document, of Google Gemini. ================ {Context} **What is Google Gemini (formerly Bard)?** Google Gemini -- formerly called Bard -- is an artificial intelligence (AI) chatbot tool designed by Google to simulate human conversations using natural language processing (NLP) and machine learning. In addition to supplementing Google Search, Gemini can be integrated into websites, messaging platforms or applications to provide realistic, natural language responses to user questions. List of tasks Google Gemini can perform. Google Gemini can be applied pragmatically to complete various tasks. Google Gemini is a family of multimodal AI large language models (LLMs) that have capabilities in language, audio, code and video understanding. Gemini 1.0 was announced on Dec. 6, 2023, and built by Alphabet's Google DeepMind business unit, which is focused on advanced AI research and development. Google co-founder Sergey Brin is credited with helping to develop the Gemini LLMs, alongside other Google staff. At its release, Gemini was the most advanced set of LLMs at Google, powering Bard before Bard's renaming and superseding the company's Pathways Language Model (Palm 2). As was the case with Palm 2, Gemini was integrated into multiple Google technologies to provide generative AI capabilities. Gemini integrates NLP capabilities, which provide the ability to understand and process language. Gemini is also used to comprehend input queries as well as data. It's able to understand and recognize images, enabling it to parse complex visuals, such as charts and figures, without the need for external optical character recognition (OCR). It also has broad multilingual capabilities for translation tasks and functionality across different languages. How does Google Gemini work? Google Gemini works by first being trained on a massive corpus of data. After training, the model uses several neural network techniques to be able to understand content, answer questions, generate text and produce outputs. Specifically, the Gemini LLMs use a transformer model-based neural network architecture. The Gemini architecture has been enhanced to process lengthy contextual sequences across different data types, including text, audio and video. Google DeepMind makes use of efficient attention mechanisms in the transformer decoder to help the models process long contexts, spanning different modalities. Gemini models have been trained on diverse multimodal and multilingual data sets of text, images, audio and video with Google DeepMind using advanced data filtering to optimize training. As different Gemini models are deployed in support of specific Google services, there's a process of targeted fine-tuning that can be used to further optimize a model for a use case. During both the training and inference phases, Gemini benefits from the use of Google's latest tensor processing unit chips, TPU v5, which are optimized custom AI accelerators designed to efficiently train and deploy large models. A key challenge for LLMs is the risk of bias and potentially toxic content. According to Google, Gemini underwent extensive safety testing and mitigation around risks such as bias and toxicity to help provide a degree of LLM safety. To help further ensure Gemini works as it should, the models were tested against academic benchmarks spanning language, image, audio, video and code domains. Google has assured the public it adheres to a list of AI principles. At launch on Dec. 6, 2023, Gemini was announced to be made up of a series of different model sizes, each designed for a specific set of use cases and deployment environments. The Ultra model is the top end and is designed for highly complex tasks. The Pro model is designed for performance and deployment at scale. As of Dec. 13, 2023, Google enabled access to Gemini Pro in Google Cloud Vertex AI and Google AI Studio. For code, a version of Gemini Pro is being used to power the Google AlphaCode 2 generative AI coding technology. The Nano model is targeted at on-device use cases. There are two different versions of Gemini Nano: Nano-1 is a 1.8 billion-parameter model, while Nano-2 is a 3.25 billion-parameter model. Among the places where Nano is being embedded is the Google Pixel 8 Pro smartphone. When was Google Bard first released? Google initially announced Bard, its AI-powered chatbot, on Feb. 6, 2023, with a vague release date. It opened access to Bard on March 21, 2023, inviting users to join a waitlist. On May 10, 2023, Google removed the waitlist and made Bard available in more than 180 countries and territories. Almost precisely a year after its initial announcement, Bard was renamed Gemini. Many believed that Google felt the pressure of ChatGPT's success and positive press, leading the company to rush Bard out before it was ready. For example, during a live demo by Google and Alphabet CEO Sundar Pichai, it responded to a query with a wrong answer. In the demo, a user asked Bard the question: "What new discoveries from the James Webb Space Telescope can I tell my 9-year-old about?" In Bard's response, it mentioned that the telescope "took the very first pictures of a planet outside of our own solar system." Astronomers quickly took to social media to point out that the first image of an exoplanet was taken by an earthbound observatory in 2004, making Bard's answer incorrect. The next day, Google lost $100 billion in market value -- a decline attributed to the embarrassing mistake. Why did Google rename Bard to Gemini and when did it happen? Bard was renamed Gemini on Feb. 8, 2024. Gemini was already the LLM powering Bard. Rebranding the platform as Gemini some believe might have been done to draw attention away from the Bard moniker and the criticism the chatbot faced when it was first released. It also simplified Google's AI effort and focused on the success of the Gemini LLM. The name change also made sense from a marketing perspective, as Google aims to expand its AI services. It's a way for Google to increase awareness of its advanced LLM offering as AI democratization and advancements show no signs of slowing. Who can use Google Gemini? Gemini is widely available around the world. Gemini Pro is available in more than 230 countries and territories, while Gemini Advanced is available in more than 150 countries at the time of this writing. However, there are age limits in place to comply with laws and regulations that exist to govern AI. Users must be at least 18 years old and have a personal Google account. However, age restrictions vary for the Gemini web app. Users in Europe must be 18 or older. In other countries where the platform is available, the minimum age is 13 unless otherwise specified by local laws. Also, users younger than 18 can only use the Gemini web app in English. Is Gemini free to use? When Bard became available, Google gave no indication that it would charge for use. Google has no history of charging customers for services, excluding enterprise-level usage of Google Cloud. The assumption was that the chatbot would be integrated into Google's basic search engine, and therefore be free to use. After rebranding Bard to Gemini on Feb. 8, 2024, Google introduced a paid tier in addition to the free web application. Pro and Nano currently are free to use via registration. However, users can only get access to Ultra through the Gemini Advanced option for $20 per month. Users sign up for Gemini Advanced through a Google One AI Premium subscription, which also includes Google Workspace features and 2 terabytes of storage. What can you use Gemini for? Use cases and applications The Google Gemini models are used in many different ways, including text, image, audio and video understanding. The multimodal nature of Gemini also enables these different types of input to be combined for generating output. Use cases Businesses can use Gemini to perform various tasks that include the following: Text summarization. Gemini models can summarize content from different types of data. Text generation. Gemini can generate text based on user prompts. That text can also be driven by a Q&A-type chatbot interface. Text translation. The Gemini models have broad multilingual capabilities, enabling translation and understanding of more than 100 languages. Image understanding. Gemini can parse complex visuals, such as charts, figures and diagrams, without external OCR tools. It can be used for image captioning and visual Q&A capabilities. Audio processing. Gemini has support for speech recognition across more than 100 languages and audio translation tasks. Video understanding. Gemini can process and understand video clip frames to answer questions and generate descriptions. Multimodal reasoning. A key strength of Gemini is its use of multimodal AI reasoning, where different types of data can be mixed for a prompt to generate an output. Code analysis and generation. Gemini can understand, explain and generate code in popular programming languages, including Python, Java, C++ and Go. Applications Google developed Gemini as a foundation model to be widely integrated across various Google services. It's also available for developers to use in building their own applications. Applications that use Gemini include the following: AlphaCode 2. Google DeepMind's AlphaCode 2 code generation tool makes use of a customized version of Gemini Pro. Google Pixel. The Google-built Pixel 8 Pro smartphone is the first device engineered to run Gemini Nano. Gemini powers new features in existing Google apps, such as summarization in Recorder and Smart Reply in Gboard for messaging apps. Android 14. The Pixel 8 Pro is the first Android smartphone to benefit from Gemini. Android developers can build with Gemini Nano through the AICore system capability. Vertex AI. Google Cloud's Vertex AI service, which provides foundation models that developers can use to build applications, also provides access to Gemini Pro. Google AI Studio. Developers can build prototypes and apps with Gemini via the Google AI Studio web-based tool. Search. Google is experimenting with using Gemini in its Search Generative Experience to reduce latency and improve quality. ================ {Task Information} Refer only to the context document in your answer. Do not employ any outside information. Use complete sentences.
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Refer only to the context document in your answer. Do not employ any outside information. Use complete sentences.
EVIDENCE:
**What is Google Gemini (formerly Bard)?** Google Gemini -- formerly called Bard -- is an artificial intelligence (AI) chatbot tool designed by Google to simulate human conversations using natural language processing (NLP) and machine learning. In addition to supplementing Google Search, Gemini can be integrated into websites, messaging platforms or applications to provide realistic, natural language responses to user questions. List of tasks Google Gemini can perform. Google Gemini can be applied pragmatically to complete various tasks. Google Gemini is a family of multimodal AI large language models (LLMs) that have capabilities in language, audio, code and video understanding. Gemini 1.0 was announced on Dec. 6, 2023, and built by Alphabet's Google DeepMind business unit, which is focused on advanced AI research and development. Google co-founder Sergey Brin is credited with helping to develop the Gemini LLMs, alongside other Google staff. At its release, Gemini was the most advanced set of LLMs at Google, powering Bard before Bard's renaming and superseding the company's Pathways Language Model (Palm 2). As was the case with Palm 2, Gemini was integrated into multiple Google technologies to provide generative AI capabilities. Gemini integrates NLP capabilities, which provide the ability to understand and process language. Gemini is also used to comprehend input queries as well as data. It's able to understand and recognize images, enabling it to parse complex visuals, such as charts and figures, without the need for external optical character recognition (OCR). It also has broad multilingual capabilities for translation tasks and functionality across different languages. How does Google Gemini work? Google Gemini works by first being trained on a massive corpus of data. After training, the model uses several neural network techniques to be able to understand content, answer questions, generate text and produce outputs. Specifically, the Gemini LLMs use a transformer model-based neural network architecture. The Gemini architecture has been enhanced to process lengthy contextual sequences across different data types, including text, audio and video. Google DeepMind makes use of efficient attention mechanisms in the transformer decoder to help the models process long contexts, spanning different modalities. Gemini models have been trained on diverse multimodal and multilingual data sets of text, images, audio and video with Google DeepMind using advanced data filtering to optimize training. As different Gemini models are deployed in support of specific Google services, there's a process of targeted fine-tuning that can be used to further optimize a model for a use case. During both the training and inference phases, Gemini benefits from the use of Google's latest tensor processing unit chips, TPU v5, which are optimized custom AI accelerators designed to efficiently train and deploy large models. A key challenge for LLMs is the risk of bias and potentially toxic content. According to Google, Gemini underwent extensive safety testing and mitigation around risks such as bias and toxicity to help provide a degree of LLM safety. To help further ensure Gemini works as it should, the models were tested against academic benchmarks spanning language, image, audio, video and code domains. Google has assured the public it adheres to a list of AI principles. At launch on Dec. 6, 2023, Gemini was announced to be made up of a series of different model sizes, each designed for a specific set of use cases and deployment environments. The Ultra model is the top end and is designed for highly complex tasks. The Pro model is designed for performance and deployment at scale. As of Dec. 13, 2023, Google enabled access to Gemini Pro in Google Cloud Vertex AI and Google AI Studio. For code, a version of Gemini Pro is being used to power the Google AlphaCode 2 generative AI coding technology. The Nano model is targeted at on-device use cases. There are two different versions of Gemini Nano: Nano-1 is a 1.8 billion-parameter model, while Nano-2 is a 3.25 billion-parameter model. Among the places where Nano is being embedded is the Google Pixel 8 Pro smartphone. When was Google Bard first released? Google initially announced Bard, its AI-powered chatbot, on Feb. 6, 2023, with a vague release date. It opened access to Bard on March 21, 2023, inviting users to join a waitlist. On May 10, 2023, Google removed the waitlist and made Bard available in more than 180 countries and territories. Almost precisely a year after its initial announcement, Bard was renamed Gemini. Many believed that Google felt the pressure of ChatGPT's success and positive press, leading the company to rush Bard out before it was ready. For example, during a live demo by Google and Alphabet CEO Sundar Pichai, it responded to a query with a wrong answer. In the demo, a user asked Bard the question: "What new discoveries from the James Webb Space Telescope can I tell my 9-year-old about?" In Bard's response, it mentioned that the telescope "took the very first pictures of a planet outside of our own solar system." Astronomers quickly took to social media to point out that the first image of an exoplanet was taken by an earthbound observatory in 2004, making Bard's answer incorrect. The next day, Google lost $100 billion in market value -- a decline attributed to the embarrassing mistake. Why did Google rename Bard to Gemini and when did it happen? Bard was renamed Gemini on Feb. 8, 2024. Gemini was already the LLM powering Bard. Rebranding the platform as Gemini some believe might have been done to draw attention away from the Bard moniker and the criticism the chatbot faced when it was first released. It also simplified Google's AI effort and focused on the success of the Gemini LLM. The name change also made sense from a marketing perspective, as Google aims to expand its AI services. It's a way for Google to increase awareness of its advanced LLM offering as AI democratization and advancements show no signs of slowing. Who can use Google Gemini? Gemini is widely available around the world. Gemini Pro is available in more than 230 countries and territories, while Gemini Advanced is available in more than 150 countries at the time of this writing. However, there are age limits in place to comply with laws and regulations that exist to govern AI. Users must be at least 18 years old and have a personal Google account. However, age restrictions vary for the Gemini web app. Users in Europe must be 18 or older. In other countries where the platform is available, the minimum age is 13 unless otherwise specified by local laws. Also, users younger than 18 can only use the Gemini web app in English. Is Gemini free to use? When Bard became available, Google gave no indication that it would charge for use. Google has no history of charging customers for services, excluding enterprise-level usage of Google Cloud. The assumption was that the chatbot would be integrated into Google's basic search engine, and therefore be free to use. After rebranding Bard to Gemini on Feb. 8, 2024, Google introduced a paid tier in addition to the free web application. Pro and Nano currently are free to use via registration. However, users can only get access to Ultra through the Gemini Advanced option for $20 per month. Users sign up for Gemini Advanced through a Google One AI Premium subscription, which also includes Google Workspace features and 2 terabytes of storage. What can you use Gemini for? Use cases and applications The Google Gemini models are used in many different ways, including text, image, audio and video understanding. The multimodal nature of Gemini also enables these different types of input to be combined for generating output. Use cases Businesses can use Gemini to perform various tasks that include the following: Text summarization. Gemini models can summarize content from different types of data. Text generation. Gemini can generate text based on user prompts. That text can also be driven by a Q&A-type chatbot interface. Text translation. The Gemini models have broad multilingual capabilities, enabling translation and understanding of more than 100 languages. Image understanding. Gemini can parse complex visuals, such as charts, figures and diagrams, without external OCR tools. It can be used for image captioning and visual Q&A capabilities. Audio processing. Gemini has support for speech recognition across more than 100 languages and audio translation tasks. Video understanding. Gemini can process and understand video clip frames to answer questions and generate descriptions. Multimodal reasoning. A key strength of Gemini is its use of multimodal AI reasoning, where different types of data can be mixed for a prompt to generate an output. Code analysis and generation. Gemini can understand, explain and generate code in popular programming languages, including Python, Java, C++ and Go. Applications Google developed Gemini as a foundation model to be widely integrated across various Google services. It's also available for developers to use in building their own applications. Applications that use Gemini include the following: AlphaCode 2. Google DeepMind's AlphaCode 2 code generation tool makes use of a customized version of Gemini Pro. Google Pixel. The Google-built Pixel 8 Pro smartphone is the first device engineered to run Gemini Nano. Gemini powers new features in existing Google apps, such as summarization in Recorder and Smart Reply in Gboard for messaging apps. Android 14. The Pixel 8 Pro is the first Android smartphone to benefit from Gemini. Android developers can build with Gemini Nano through the AICore system capability. Vertex AI. Google Cloud's Vertex AI service, which provides foundation models that developers can use to build applications, also provides access to Gemini Pro. Google AI Studio. Developers can build prototypes and apps with Gemini via the Google AI Studio web-based tool. Search. Google is experimenting with using Gemini in its Search Generative Experience to reduce latency and improve quality.
USER:
Summarize the possible uses, that are addressed in the provided document, of Google Gemini.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 18 | 14 | 1,623 | null | 567 |
You can only respond to the prompt using the information in the context block and no other sources.
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List the pros and cons for Nestle in regards to this deal.
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Nestlé and Starbucks close deal for the perpetual global license of Starbucks Consumer Packaged Goods and Foodservice products Vevey and Seattle, 28 August 2018 – Nestlé and Starbucks Corporation today announced the closing of the deal granting Nestlé the perpetual rights to market Starbucks Consumer Packaged Goods and Foodservice products globally, outside of the company’s coffee shops. Through the alliance, the two companies will work closely together on the existing Starbucks range of roast and ground coffee, whole beans as well as instant and portioned coffee. The alliance will also capitalize on the experience and capabilities of both companies to work on innovation with the goal of enhancing its product offerings for coffee lovers globally. “This partnership demonstrates our growth agenda in action, giving Nestlé an unparalleled position in the coffee business with a full suite of innovative brands. With Starbucks, Nescafé and Nespresso we bring together the world’s most iconic coffee brands,” said Mark Schneider, Nestlé CEO. “The outstanding collaboration between the two teams resulted in a swift completion of this agreement, which will pave the way to capture further growth opportunities,” he added. The agreement significantly strengthens Nestlé’s coffee portfolio in the North American premium roast and ground and portioned coffee business. It also unlocks global expansion in grocery and food service for the Starbucks brand, utilizing the global reach of Nestlé. “This global coffee alliance with Nestlé is a significant strategic milestone for the growth of Starbucks,” said Kevin Johnson, president and ceo of Starbucks. “Bringing together the world’s leading coffee retailer, the world’s largest food and beverage company, and the world’s largest and fast-growing installed base of at-home and single-serve coffee machines helps us amplify the Starbucks brand around the world while delivering long-term value creation for our shareholders.” Approximately 500 Starbucks employees in the United States and Europe will join the Nestlé family, with the majority based in Seattle and London. The international expansion of the business will be led from Nestlé’s global headquarters in Vevey, Switzerland. The agreement covers Starbucks packaged coffee and tea brands, such as Starbucks®, Seattle’s Best Coffee®, TeavanaTM/MC, Starbucks VIA® Instant, Torrefazione Italia® coffee and Starbucks-branded
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You can only respond to the prompt using the information in the context block and no other sources. Nestlé and Starbucks close deal for the perpetual global license of Starbucks Consumer Packaged Goods and Foodservice products Vevey and Seattle, 28 August 2018 – Nestlé and Starbucks Corporation today announced the closing of the deal granting Nestlé the perpetual rights to market Starbucks Consumer Packaged Goods and Foodservice products globally, outside of the company’s coffee shops. Through the alliance, the two companies will work closely together on the existing Starbucks range of roast and ground coffee, whole beans as well as instant and portioned coffee. The alliance will also capitalize on the experience and capabilities of both companies to work on innovation with the goal of enhancing its product offerings for coffee lovers globally. “This partnership demonstrates our growth agenda in action, giving Nestlé an unparalleled position in the coffee business with a full suite of innovative brands. With Starbucks, Nescafé and Nespresso we bring together the world’s most iconic coffee brands,” said Mark Schneider, Nestlé CEO. “The outstanding collaboration between the two teams resulted in a swift completion of this agreement, which will pave the way to capture further growth opportunities,” he added. The agreement significantly strengthens Nestlé’s coffee portfolio in the North American premium roast and ground and portioned coffee business. It also unlocks global expansion in grocery and food service for the Starbucks brand, utilizing the global reach of Nestlé. “This global coffee alliance with Nestlé is a significant strategic milestone for the growth of Starbucks,” said Kevin Johnson, president and ceo of Starbucks. “Bringing together the world’s leading coffee retailer, the world’s largest food and beverage company, and the world’s largest and fast-growing installed base of at-home and single-serve coffee machines helps us amplify the Starbucks brand around the world while delivering long-term value creation for our shareholders.” Approximately 500 Starbucks employees in the United States and Europe will join the Nestlé family, with the majority based in Seattle and London. The international expansion of the business will be led from Nestlé’s global headquarters in Vevey, Switzerland. The agreement covers Starbucks packaged coffee and tea brands, such as Starbucks®, Seattle’s Best Coffee®, TeavanaTM/MC, Starbucks VIA® Instant, Torrefazione Italia® coffee and Starbucks-branded List the pros and cons for Nestle in regards to this deal.
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You can only respond to the prompt using the information in the context block and no other sources.
EVIDENCE:
Nestlé and Starbucks close deal for the perpetual global license of Starbucks Consumer Packaged Goods and Foodservice products Vevey and Seattle, 28 August 2018 – Nestlé and Starbucks Corporation today announced the closing of the deal granting Nestlé the perpetual rights to market Starbucks Consumer Packaged Goods and Foodservice products globally, outside of the company’s coffee shops. Through the alliance, the two companies will work closely together on the existing Starbucks range of roast and ground coffee, whole beans as well as instant and portioned coffee. The alliance will also capitalize on the experience and capabilities of both companies to work on innovation with the goal of enhancing its product offerings for coffee lovers globally. “This partnership demonstrates our growth agenda in action, giving Nestlé an unparalleled position in the coffee business with a full suite of innovative brands. With Starbucks, Nescafé and Nespresso we bring together the world’s most iconic coffee brands,” said Mark Schneider, Nestlé CEO. “The outstanding collaboration between the two teams resulted in a swift completion of this agreement, which will pave the way to capture further growth opportunities,” he added. The agreement significantly strengthens Nestlé’s coffee portfolio in the North American premium roast and ground and portioned coffee business. It also unlocks global expansion in grocery and food service for the Starbucks brand, utilizing the global reach of Nestlé. “This global coffee alliance with Nestlé is a significant strategic milestone for the growth of Starbucks,” said Kevin Johnson, president and ceo of Starbucks. “Bringing together the world’s leading coffee retailer, the world’s largest food and beverage company, and the world’s largest and fast-growing installed base of at-home and single-serve coffee machines helps us amplify the Starbucks brand around the world while delivering long-term value creation for our shareholders.” Approximately 500 Starbucks employees in the United States and Europe will join the Nestlé family, with the majority based in Seattle and London. The international expansion of the business will be led from Nestlé’s global headquarters in Vevey, Switzerland. The agreement covers Starbucks packaged coffee and tea brands, such as Starbucks®, Seattle’s Best Coffee®, TeavanaTM/MC, Starbucks VIA® Instant, Torrefazione Italia® coffee and Starbucks-branded
USER:
List the pros and cons for Nestle in regards to this deal.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 18 | 12 | 356 | null | 406 |
You can only respond to the prompt using information in the context block.
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Discuss the concept of military necessity as outlined in this article and its relationship to contemporary asymmetric conflict.
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Abstract Inequality in arms, indeed, significant disparity between belligerents, has become a prominent feature of various contemporary armed conflicts. Such asymmetries, albeit not at all a new phenomenon in the field of warfare, no longer constitute a random occurrence of singular battles. As a structural characteristic of modern-day warfare asymmetric conflict structures have repercussions on the application of fundamental principles of international humanitarian law. How, for example, can the concept of military necessity, commonly understood to justify the degree of force necessary to secure military defeat of the enemy, be reconciled with a constellation in which one side in the conflict is from the outset bereft of any chance of winning the conflict militarily? Moreover, military imbalances of this scope evidently carry incentives for the inferior party to level out its inferiority by circumventing accepted rules of warfare. This article attempts tentatively to assess the repercussions this could have on the principle of reciprocity, especially the risk of the instigation of a destabilizing dynamic of negative reciprocity which ultimately could lead to a gradual intensification of a mutual disregard of international humanitarian law. Introduction With only one remaining superpower and more generally the considerable and predictably widening technological divide, an imbalance in the military capacity of warring parties has become a characteristic feature of contemporary armed conflicts. Coupled with a growing involvement of non-state entities, the disparity between belligerents is steadily increasing, and various contemporary armed conflicts appear to be more and more asymmetric in structure. Unlike the geostrategic set-up that prevailed throughout the cold war period, it is a widely perceived paradox of today’s strategic environment that military superiority may actually accentuate the threat of nuclear, biological, chemical and, generally speaking, perfidious attack. Indeed, direct attacks against civilians, hostage-taking and the use of human shields – practices that have long been outlawed in armed conflicts– have seen a revival in recent conflicts in which the far weaker party has often sought to gain a comparative advantage over the militarily superior enemy by resorting to such practices as a matter of strategy. International terrorism, although not necessarily conducted within the context of an armed conflict triggering the application of international humanitarian law (IHL), is often regarded as the epitome of such asymmetry. At the same time militarily superior parties at the other end of the spectrum have had recourse to indiscriminate attacks, illegal interrogation practices and renditions, as well as legally dubious practices such as targeted killings or hardly reviewable covert operations, in order to strike at their frequently amorphous enemy. Significant inequality of arms, that is a disparate distribution of military strength and technological capability in a given conflict, seemingly creates incentives for adversaries to resort to means and methods of warfare that undermine and are sometimes an outright violation of long-accepted standards of international humanitarian law. The war between the US-led Coalition and Iraq or the war in Afghanistan are clear examples. This tendency is reinforced if belligerents differ in nature, as in the recent conflict between Israel and Hezbollah (‘‘party of God’’)– the Lebanon-based Shia Islamic militia and political organization– or if factual asymmetries are combined with a legal asymmetry, that is in a constellation in which one side is accorded little or no legal standing. To be sure, perfect symmetries have rarely been present in war. However, the patterns of non-compliance displayed in various contemporary conflicts seem to be more structured and systematic than ever before. The present study first seeks to verify this assumption. It considers whether factual and potentially legal asymmetries do indeed constitute an incentive for breaches of international humanitarian law provisions, and, if so, how patterns of contemporary conflicts differ from those of previous conflicts that likewise exhibited discernible asymmetries. In a second step, closer scrutiny is given to the actual patterns of non-compliance in asymmetric scenarios, particularly in the light of the interplay of the principle of distinction and the principle of proportionality. Neither the term ‘‘asymmetric warfare’’ nor the sometimes synonymously employed terms ‘‘fourth-generation warfare’’ or ‘‘non-linear war’’ have thus far been concordantly defined.3 It is not the intention of this study to venture into this perhaps impenetrable terrain. Analysis shows, however, that there is a noticeable tendency in contemporary conflicts towards an increasing inequality between belligerents in terms of weaponry. While this is a long-known phenomenon in non-international armed conflicts, evaluation of the effects of military disparity in international armed conflicts continues, as does the debate over the extent to which transnational conflicts involving states and non-state entities should be subject to the laws of war. In attempting to approach this debate from a somewhat different angle, it is the overall purpose of this study to gauge the long-term repercussions that asymmetric conflict structures may have on the fundamental principles of international humanitarian law and thereby tentatively to assess the degree of asymmetry– that is, the level of military disparity between belligerents– that can still be reconciled with the legal regime applicable in times of war.5 To this end the study, in a third step, weighs the traditional concept of military necessity as laid down in the Lieber Code of 1863 against the promulgated necessities in asymmetric conflicts of our time. Even though the fundamental concepts and principles of the laws of war have been designed as prophylactic mechanisms flexible enough to outlast changes in the way in which wars are waged, it is here contended that the concept of military necessity and the principle of distinction presuppose a minimum degree of symmetry and therefore cannot be applied in subordinative constellations akin to human rights patterns, as are commonly seen in the fight against international terrorism. The vantage point for the fourth and final part of the analysis is the principle of reciprocity. As the military mismatch between conflicting parties in numerous modern armed conflicts becomes more marked, the balancing influence of the reciprocity entailed by the traditional concept of symmetric warfare is gradually being undermined.6 While the deterrent effects of an increasingly effective system of international criminal law and of media coverage and public opinion– although the last two are ambivalent factors that could also be used for the opposite purpose– could arguably help to contain non-compliant behaviour in war, international humanitarian law might thus be simultaneously bereft of its own inherent regulating mechanisms which have traditionally taken effect in the combat zone itself. The destabilizing dynamic of reciprocity could lead to a gradual and perhaps insidious erosion of the protective scope of core principles of international humanitarian law. Repeated violations of, for example, the principle of distinction by one party to a conflict are likely to induce the other side to expand its perception of what is militarily necessary, and hence proportional, when engaging in battle against such an enemy. In the final stage, and admittedly only as a worst-case scenario, an intentional and deceitful deviation from accepted standards regulating the conduct of hostilities carries the considerable risk of starting a vicious circle of ever greater negative reciprocity, in which the expectations of the warring parties are transformed into an escalating mutual noncompliance with international humanitarian law. A heightened risk of structural non-compliance? Historically, the majority of laws on international armed conflict have been designed on the basis of Clausewitz’s arguably rather Eurocentric conception of war, that is, the assumption of symmetric conflicts taking place between state armies of roughly equal military strength or at least comparable organizational structures. Throughout most of the nineteenth and twentieth centuries the dominant powers engaged in sustained arms races either to maintain a peace ensuring symmetry or to establish a tactical asymmetry vis-a `-vis their opponents as a guarantee of military victory in war.7 But quite apart from the biblical story of David and Goliath it is evident that asymmetry in the sense of military disparity is no new phenomenon.8 Nor is it a concept entirely alien to IHL. With the intrinsic disparity of the parties concerned, and even though the threshold criteria of Article 1 of Additional Protocol II to the 1949 Geneva Conventions arguably help to ensure a minimum degree of comparability between those parties, non-international armed conflicts are inherently asymmetric. It was moreover already accepted in the classic concept of symmetric warfare that the structure of conflicts could shift from symmetric to asymmetric, for by the time a conflict drew to its close and one party had gained the upper hand, the initial military balance would be out of kilter. More recently, during the Diplomatic Conference that led to the adoption of Additional Protocol I, states taking part not only acknowledged the persistence of significant disparities in military capacity but accepted that factual disparity between opponents may even lead to differing humanitarian law obligations. For example, with respect to Article 57 of Additional Protocol I on the obligation to take precautions in attack,9 the Indian delegation pointed out that according to the chosen wording the content of the due diligence obligation enshrined therein– that is, the precise identification of objectives as military or civilian– largely depended on the technical means of detection available to the belligerents.10 Despite these concerns, the present wording was accepted on the implicit understanding that because of prevailing factual disparities, international humanitarian law obligations may impose differing burdens in practice.11 Schwarzenberger has pointed out that the protective scope of the laws of war has historically been the strongest in duel-type wars between comparable belligerents that were fought for limited purposes, such as the Crimean War of 1853–6 or the Franco-German War of 1870–1, whereas in major wars such as the Napoleonic wars or the two world wars of the twentieth century– wars that were fought to the bitter end– the weaker side often tended to seek short-term advantages by violating the laws of war.12 Indeed, violations of the laws of war have occurred in nearly every case in which IHL has been applicable,13 and the risk that one party may order or connive in large-scale violations of the laws of war in order to gain a tempting advantage or stave off in some way an otherwise threatening defeat has always hovered over the legal regime intended to regulate conduct in armed conflicts.14 However, in symmetric constellations such instances have tended to remain marginal, often limited to the final stages of a war and confined to individual battles in which defeat seemed inevitable, or resort to perfidy or similarly prohibited tactics was perceived as guaranteeing an immediate tactical breakthrough in what was otherwise a military stalemate. As a result of the evident disparate military capabilities of opponents in certain contemporary conflicts, incentives for violations of IHL seem in comparison to have reached a new height. Non-compliance with the provisions of IHL is no longer a random event, confined to temporally and spatially limited incidents within a conflict, but has become a recurrent structural feature that characterizes many of today’s armed conflicts from the outset. The reason is that, faced with an enemy of overwhelming technological superiority, the weaker party ab initio has no chance of winning the war militarily. Figures from the recent war against Iraq illustrate this imbalance of power and capacity quite well. While the Iraqi air force reportedly never left the ground, Coalition forces flew rather more than 20,000 sorties, during which only one fixed-wing aircraft and only seven aircraft in all were lost to hostile fire.15 Evidence of a comparable inequality in the military capability of belligerents will probably become available in the aftermath of the recent conflict in Lebanon. Without anticipating the more detailed analysis below, it should be noted that the Iraqi army’s widespread infringements during the international conflict against the US-led Coalition, as well as Hezbollah’s indiscriminate attacks, stem to a significant extent from the blatant inequality in weaponry. Practices employed by the Iraqi army included recourse to human shields, abuse of the red cross and red crescent emblems, the use of anti-personnel mines and the placing of military objects in protected areas such as mosques and hospitals. Clearly, there is thus an elevated risk that the militarily inferior party, unable to identify any military weaknesses of its superior opponent, may feel compelled systematically to offset the enemy’s superiority by resorting to means and methods of warfare outside the realm of international humanitarian law. At the same time the use of ‘‘unthinkable’’ tactics as well as the tactical circumvention of accepted IHL standards creates a barrier that cannot be readily overcome by military superiority alone. Apart from the ongoing hostilities in Iraq, the tactics employed by the Somali tribal leader Farah Aydid in 1993 are a good example of this. In conventional terms, his forces were no match for heavily armed and technologically sophisticated airborne US troops. However, by using primitive weapons and communication systems– which reportedly varied from cellular phones to tribal drums– and by resorting to ‘‘unthinkable’’ tactics and to ‘‘barbaric’’ acts perpetrated for the benefit of the news media, the militia convinced the leadership of the United States that despite the military backwardness of the Somali forces the price of involvement in Somalia was very high. In the course of the war against Iraq the use of cluster munitions in populated areas, as well as the alleged use of white phosphorus and the continued recourse by US and British forces to ‘‘decapitation’’ strikes that caused high numbers of civilian casualties, partly constituted indiscriminate attacks and arguably a failure to take ‘‘all feasible precautions’’ as required by IHL. There are thus apparent incentives for both sides to give increasing priority, potentially to the detriment of humanitarian considerations, to the necessities of such a kind of warfare. Patterns of non-compliance: the interplay between the principle of distinction and the principle of proportionality Recent conflict patterns suggest that militarily inferior parties, in order to evade attack by an enemy of insurmountable superiority or to level out inequalities in military power, tend in particular to instrumentalize and intentionally manipulate the principle of distinction. This manipulation may occur in different ways.18 Similarly, superior parties are likely to lower the barrier of proportionality in response to a systematic misuse of the principle of distinction and their resulting inability to tackle the enemy effectively. The following description of potential strategies that belligerents may feel compelled to adopt when faced with overwhelming odds or systematic deviations from accepted legal rules is merely intended to facilitate understanding of likely patterns of non-compliance and does not claim to be comprehensive. It is part of the very nature of asymmetric strategies that they are impossible to predict. The principle of distinction As a defensive strategy when facing a technologically superior enemy it is essential, but ever more difficult, to stay out of reach and conceal one’s presence as a combatant. Hiding in mountainous areas, caves, underground facilities and tunnels is one way. However, another means of doing so quickly and efficiently is readily available by virtue of the provisions of IHL themselves. In view of the various forms of protection accorded to civilians, assuming civilian guise is an easy way to evade the enemy and, unlike the more traditional guerrilla-style tactics of hiding underground or in inaccessible areas, it cannot be countered by the development of advanced discovery technologies. Indeed, in order to keep Coalition forces from identifying them as enemies, that is as legitimate targets, many Iraqi soldiers in the recent war reportedly quite often discarded their uniforms. This is not a prohibited tactic, as long as such practices are not used to launch an attack under the cover of protected status; according to Article 4 of the Third Geneva Convention the absence of any fixed distinctive sign recognizable at a distance merely leads to the loss of combatant status and the corresponding privileges. Still, despite its legality such a practice will, if employed as a matter of strategy, create considerable uncertainty about a person’s status and thus subtly erode the effectiveness of the fundamental and, in the words of the International Court of Justice (ICJ), intransgressible principle of distinction. Evidently the notion of distinction, that is, the legally prescribed invulnerability of certain persons and objects, can if manipulated offer manifold loopholes for the evasion of attack.22 The dividing line between legal tactics and illegitimate practices is easily crossed. The misuse of protective emblems for the concealment of military objects is a case in point, and the marking of the Ba’ath Party building in Basra with the ICRC emblem is a flagrant example of such tactics.23 To protect military objects whose nature could not be so readily concealed, weaker warring parties have repeatedly utilized the proportionality barrier: in order to manipulate the adversary’s proportionality equation, immobile military objects are shielded by civilians, while mobile military equipment is intentionally sited close to civilian installations or other specifically protected locations. For example, in the recent conflict in the Middle East Hezbollah hid its rockets and military equipment in civilian neighbourhoods, and UN UnderSecretary-General Jan Egeland’s statement clearly points to the vicious circle that might be triggered by such a practice.24 Similar modes of conduct have been employed with regard to offensive tactics. The reported seizure of ambulance vehicles in order to feign protected status and thus improve the chances of attacking is a typical example, as is the fact that during the battle of Fallujah in November 2004 sixty of the city’s one hundred mosques were reportedly used as bases for military operations.25 It should be noted that, besides violating the principle of distinction, creating the false impression of legal entitlement to immunity from attack and exploiting the enemy’s confidence in that status also amount to perfidy and are prohibited as such.26 Not each and every strategy employed to circumvent superior military power by cunning, surprise, indirect approach or ruthlessness automatically constitutes prohibited conduct; it may, depending on the circumstances, amount to no more than good tactics. However, if unable to identify any military weaknesses of a superior enemy, the weaker opponent may ultimately see no other alternative than to aim for the stronger state’s soft underbelly and attack civilians or civilian objects directly, in outright violation of the principle of distinction. The series of terrorist attacks in the aftermath of 9/11, that is, the attacks in Bali, Mombasa and Djerba in 2002, Riyadh and Casablanca in 2003, Madrid in 2004, London and Cairo in 2005 and Mumbai in 2006– to mention only those which have received the greatest media attention– and the constant attacks in Afghanistan and Iraq, shows that this tendency is increasing. Avoiding the risks of attacking well-protected military installations, it enables the weaker opponent to wage an offensive war on the television screens and in the homes of the stronger state and to benefit from the repercussive effects of mass media coverage.27 The principle of proportionality Over time there is a considerable risk that in view of the aforesaid practices, international humanitarian law itself, with its clear-cut categorizations and differentiations between military and civil, may be perceived by a belligerent confronted with repeated violations by its opponent as opening the doors to a kind of war which intentionally does away with such clear demarcations.28 However, the more immediate risk is that the adversary, faced with such a misuse of the principle of distinction, could feel compelled gradually to lower the proportionality barrier. Evidently, if the use of human shields or the concealment of military equipment among civilian facilities occurs only sporadically and at random in an armed conflict, humanitarian concerns are likely to outweigh the necessity to attack using disproportionate force, whereas if such tactics are systematically employed for a strategic purpose, the enemy may feel a compelling and overriding necessity to attack irrespective of the anticipated civilian casualties and damage. Indeed, the explanation given by the Israeli government for the mounting number of civilian casualties in its recent military operations against Hezbollah in Lebanon29 confirms that systematic violation of, for example, the principle of distinction by one side during a conflict is likely adversely to affect the other side’s interpretation and application of the proportionality principle. Military necessity in asymmetric conflicts Although the concept of military necessity is invoked now and then as a separate justification for violations of the laws of war, today there can be no doubt that in contemporary international humanitarian law the element of military necessity must be balanced against the principle of humanity, and that there is no such elasticity in the laws of war that military necessity can be claimed as a reason to deviate from accepted humanitarian standards. Nevertheless, asymmetric conflict arguably entails a certain risk of the emergence of a modern-day Kriegsrason because obstacles seen as insurmountable could make both sides feel inclined and ultimately compelled vastly to expand their perception of what is necessary to overcome the enemy. Since military necessity is a component of the ius in bello equation of proportionality, to expand or overemphasize the concept of military necessity would impair the protective scope of the proportionality principle.33 The principle of military necessity is closely linked to the objectives of war. However, the objectives sought in asymmetric conflicts vary significantly from those sought in the kind of symmetric conflict constellations which the drafting fathers of the principle of military necessity had in mind. Modern authorities on the laws of war continue to refer to the definition of military necessity laid down in Article 14 of the Lieber Code, according to which ‘‘Military necessity, as understood by modern civilized nations, consists in the necessity of those measures which are indispensable for securing the ends of the war, and which are lawful according to the modern law and usages of war.’’ In view of the formulation ‘‘indispensable for securing the ends of war’’, the principle of military necessity is commonly understood to justify only that degree of force necessary to secure military defeat and the prompt submission of the enemy.37 Indeed, the Declaration of St Petersburg states as early as 1868 that ‘‘the only legitimate object which States should endeavour to accomplish during war is to weaken the military forces of the enemy’’38 and the US Army Field Manual stipulates that ‘‘The law of war … requires that belligerents refrain from employing any kind or degree of violence which is not actually necessary for military purposes’’ and defines military necessity as ‘‘that principle which justifies those measures not forbidden by international law which are indispensable for the complete submission of the enemy as soon as possible’’. Historically, the rather strict alignment of the concept of military necessity with exclusively military objectives, that is, military defeat and the prompt military submission of the enemy, is due to the fact that the concept was originally designed to restrain violence in war. Although sometimes overlooked today, restrictions on violence in war do not merely stem from balancing the principle of military necessity against the principle of humanity.41 The principle of military necessity in and of itself constitutes an important restrictive factor by prescribing that to be legitimate, violence in war first of all has to be militarily necessary.42 A gradual, clandestine widening of this concept, or simply a more lenient understanding of the factors that determine military necessity and hence the notion of military advantage, would therefore undermine the restrictive standards imposed on the use of violence in armed conflicts. Such a process seems particularly likely in view of asymmetric constellations which, owing to their complexity and intangibility, escape any military apprehension stricto sensu. For example, application of the rule of proportionality as laid down in Articles 51 and 57 of Additional Protocol I is significantly affected, even in traditional armed conflicts, by whether the notion of military advantage is understood to mean the advantage anticipated from an attack considered as a whole or merely from isolated or particular parts of the attack.43 In asymmetric constellations that elude both temporal and spatial boundaries– in other words, the traditional concept of the ‘‘battlefield’’ altogether– it would seem somewhat difficult to delineate and determine with any degree of precision what is meant by the notion of ‘‘an attack considered as a whole’’.44 More generally, as the asymmetry between belligerents increases, the distinction between political and military objectives and necessities becomes more and more blurred. Especially in conflicts such as those against al Qaeda or Hezbollah, that is, conflicts between a state or group of states and a non-state entity, that entity’s ultimate aim in using military force will be to exert pressure on the politics of the enemy rather than even attempt to achieve the latter’s military submission. Conversely, the superior party is likely to adopt a far more holistic approach, inseparably combining political and military efforts to bring about the entire political eradication or dissolution of the enemy and not just the enemy’s military submission– especially if it is battling against a non-state entity it categorizes as a terrorist organization.45 To be sure, the separation of military and political aims already present in traditional warfare has always been axiomatic to some extent, given that each and every military operation emanates from both military and political motivations.46 The so-called Christmas bombing of North Vietnam in 1972 is a typical example: even though solely military objectives within the definition thereof were targeted, its purpose was to induce the North Vietnamese government to proceed with political negotiations. Nonetheless, symmetric warfare with its identifiable battlefields in terms of space and duration did allow, at least in theory, a relatively clear separation of military and political necessities and objectives in the actual conduct of warfare. In asymmetric scenarios, however, the weaker adversary is militarily outmatched from the start, military superiority in itself is no longer a reliable guarantee for winning such conflicts and the very notions of ‘‘victory’’ or ‘‘defeat’’ thus become more and more indistinct. If these parameters remain undefined or even indefinable, straightforward determinations of what is militarily necessary are impeded. Military necessities have always been subject to change as warfare has developed, and the concept of military necessity has been flexible enough to adapt accordingly as long as that development largely resulted from technological advances in weaponry. Yet it seems doubtful whether asymmetric constellations akin to law enforcement patterns could still be grasped by and measured against the concept of military necessity,48 for the complexities and intangibility of such scenarios escape its traditionally narrow delimitations. To compromise the concept’s very narrowness, however, would mean compromising long-achieved humanitarian protections that flow directly from the concept itself and could shift the focus of the proportionality equation away from humanitarian considerations and towards military necessities.
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You can only respond to the prompt using information in the context block. Discuss the concept of military necessity as outlined in this article and its relationship to contemporary asymmetric conflict. Abstract Inequality in arms, indeed, significant disparity between belligerents, has become a prominent feature of various contemporary armed conflicts. Such asymmetries, albeit not at all a new phenomenon in the field of warfare, no longer constitute a random occurrence of singular battles. As a structural characteristic of modern-day warfare asymmetric conflict structures have repercussions on the application of fundamental principles of international humanitarian law. How, for example, can the concept of military necessity, commonly understood to justify the degree of force necessary to secure military defeat of the enemy, be reconciled with a constellation in which one side in the conflict is from the outset bereft of any chance of winning the conflict militarily? Moreover, military imbalances of this scope evidently carry incentives for the inferior party to level out its inferiority by circumventing accepted rules of warfare. This article attempts tentatively to assess the repercussions this could have on the principle of reciprocity, especially the risk of the instigation of a destabilizing dynamic of negative reciprocity which ultimately could lead to a gradual intensification of a mutual disregard of international humanitarian law. Introduction With only one remaining superpower and more generally the considerable and predictably widening technological divide, an imbalance in the military capacity of warring parties has become a characteristic feature of contemporary armed conflicts. Coupled with a growing involvement of non-state entities, the disparity between belligerents is steadily increasing, and various contemporary armed conflicts appear to be more and more asymmetric in structure. Unlike the geostrategic set-up that prevailed throughout the cold war period, it is a widely perceived paradox of today’s strategic environment that military superiority may actually accentuate the threat of nuclear, biological, chemical and, generally speaking, perfidious attack. Indeed, direct attacks against civilians, hostage-taking and the use of human shields – practices that have long been outlawed in armed conflicts– have seen a revival in recent conflicts in which the far weaker party has often sought to gain a comparative advantage over the militarily superior enemy by resorting to such practices as a matter of strategy. International terrorism, although not necessarily conducted within the context of an armed conflict triggering the application of international humanitarian law (IHL), is often regarded as the epitome of such asymmetry. At the same time militarily superior parties at the other end of the spectrum have had recourse to indiscriminate attacks, illegal interrogation practices and renditions, as well as legally dubious practices such as targeted killings or hardly reviewable covert operations, in order to strike at their frequently amorphous enemy. Significant inequality of arms, that is a disparate distribution of military strength and technological capability in a given conflict, seemingly creates incentives for adversaries to resort to means and methods of warfare that undermine and are sometimes an outright violation of long-accepted standards of international humanitarian law. The war between the US-led Coalition and Iraq or the war in Afghanistan are clear examples. This tendency is reinforced if belligerents differ in nature, as in the recent conflict between Israel and Hezbollah (‘‘party of God’’)– the Lebanon-based Shia Islamic militia and political organization– or if factual asymmetries are combined with a legal asymmetry, that is in a constellation in which one side is accorded little or no legal standing. To be sure, perfect symmetries have rarely been present in war. However, the patterns of non-compliance displayed in various contemporary conflicts seem to be more structured and systematic than ever before. The present study first seeks to verify this assumption. It considers whether factual and potentially legal asymmetries do indeed constitute an incentive for breaches of international humanitarian law provisions, and, if so, how patterns of contemporary conflicts differ from those of previous conflicts that likewise exhibited discernible asymmetries. In a second step, closer scrutiny is given to the actual patterns of non-compliance in asymmetric scenarios, particularly in the light of the interplay of the principle of distinction and the principle of proportionality. Neither the term ‘‘asymmetric warfare’’ nor the sometimes synonymously employed terms ‘‘fourth-generation warfare’’ or ‘‘non-linear war’’ have thus far been concordantly defined.3 It is not the intention of this study to venture into this perhaps impenetrable terrain. Analysis shows, however, that there is a noticeable tendency in contemporary conflicts towards an increasing inequality between belligerents in terms of weaponry. While this is a long-known phenomenon in non-international armed conflicts, evaluation of the effects of military disparity in international armed conflicts continues, as does the debate over the extent to which transnational conflicts involving states and non-state entities should be subject to the laws of war. In attempting to approach this debate from a somewhat different angle, it is the overall purpose of this study to gauge the long-term repercussions that asymmetric conflict structures may have on the fundamental principles of international humanitarian law and thereby tentatively to assess the degree of asymmetry– that is, the level of military disparity between belligerents– that can still be reconciled with the legal regime applicable in times of war.5 To this end the study, in a third step, weighs the traditional concept of military necessity as laid down in the Lieber Code of 1863 against the promulgated necessities in asymmetric conflicts of our time. Even though the fundamental concepts and principles of the laws of war have been designed as prophylactic mechanisms flexible enough to outlast changes in the way in which wars are waged, it is here contended that the concept of military necessity and the principle of distinction presuppose a minimum degree of symmetry and therefore cannot be applied in subordinative constellations akin to human rights patterns, as are commonly seen in the fight against international terrorism. The vantage point for the fourth and final part of the analysis is the principle of reciprocity. As the military mismatch between conflicting parties in numerous modern armed conflicts becomes more marked, the balancing influence of the reciprocity entailed by the traditional concept of symmetric warfare is gradually being undermined.6 While the deterrent effects of an increasingly effective system of international criminal law and of media coverage and public opinion– although the last two are ambivalent factors that could also be used for the opposite purpose– could arguably help to contain non-compliant behaviour in war, international humanitarian law might thus be simultaneously bereft of its own inherent regulating mechanisms which have traditionally taken effect in the combat zone itself. The destabilizing dynamic of reciprocity could lead to a gradual and perhaps insidious erosion of the protective scope of core principles of international humanitarian law. Repeated violations of, for example, the principle of distinction by one party to a conflict are likely to induce the other side to expand its perception of what is militarily necessary, and hence proportional, when engaging in battle against such an enemy. In the final stage, and admittedly only as a worst-case scenario, an intentional and deceitful deviation from accepted standards regulating the conduct of hostilities carries the considerable risk of starting a vicious circle of ever greater negative reciprocity, in which the expectations of the warring parties are transformed into an escalating mutual noncompliance with international humanitarian law. A heightened risk of structural non-compliance? Historically, the majority of laws on international armed conflict have been designed on the basis of Clausewitz’s arguably rather Eurocentric conception of war, that is, the assumption of symmetric conflicts taking place between state armies of roughly equal military strength or at least comparable organizational structures. Throughout most of the nineteenth and twentieth centuries the dominant powers engaged in sustained arms races either to maintain a peace ensuring symmetry or to establish a tactical asymmetry vis-a `-vis their opponents as a guarantee of military victory in war.7 But quite apart from the biblical story of David and Goliath it is evident that asymmetry in the sense of military disparity is no new phenomenon.8 Nor is it a concept entirely alien to IHL. With the intrinsic disparity of the parties concerned, and even though the threshold criteria of Article 1 of Additional Protocol II to the 1949 Geneva Conventions arguably help to ensure a minimum degree of comparability between those parties, non-international armed conflicts are inherently asymmetric. It was moreover already accepted in the classic concept of symmetric warfare that the structure of conflicts could shift from symmetric to asymmetric, for by the time a conflict drew to its close and one party had gained the upper hand, the initial military balance would be out of kilter. More recently, during the Diplomatic Conference that led to the adoption of Additional Protocol I, states taking part not only acknowledged the persistence of significant disparities in military capacity but accepted that factual disparity between opponents may even lead to differing humanitarian law obligations. For example, with respect to Article 57 of Additional Protocol I on the obligation to take precautions in attack,9 the Indian delegation pointed out that according to the chosen wording the content of the due diligence obligation enshrined therein– that is, the precise identification of objectives as military or civilian– largely depended on the technical means of detection available to the belligerents.10 Despite these concerns, the present wording was accepted on the implicit understanding that because of prevailing factual disparities, international humanitarian law obligations may impose differing burdens in practice.11 Schwarzenberger has pointed out that the protective scope of the laws of war has historically been the strongest in duel-type wars between comparable belligerents that were fought for limited purposes, such as the Crimean War of 1853–6 or the Franco-German War of 1870–1, whereas in major wars such as the Napoleonic wars or the two world wars of the twentieth century– wars that were fought to the bitter end– the weaker side often tended to seek short-term advantages by violating the laws of war.12 Indeed, violations of the laws of war have occurred in nearly every case in which IHL has been applicable,13 and the risk that one party may order or connive in large-scale violations of the laws of war in order to gain a tempting advantage or stave off in some way an otherwise threatening defeat has always hovered over the legal regime intended to regulate conduct in armed conflicts.14 However, in symmetric constellations such instances have tended to remain marginal, often limited to the final stages of a war and confined to individual battles in which defeat seemed inevitable, or resort to perfidy or similarly prohibited tactics was perceived as guaranteeing an immediate tactical breakthrough in what was otherwise a military stalemate. As a result of the evident disparate military capabilities of opponents in certain contemporary conflicts, incentives for violations of IHL seem in comparison to have reached a new height. Non-compliance with the provisions of IHL is no longer a random event, confined to temporally and spatially limited incidents within a conflict, but has become a recurrent structural feature that characterizes many of today’s armed conflicts from the outset. The reason is that, faced with an enemy of overwhelming technological superiority, the weaker party ab initio has no chance of winning the war militarily. Figures from the recent war against Iraq illustrate this imbalance of power and capacity quite well. While the Iraqi air force reportedly never left the ground, Coalition forces flew rather more than 20,000 sorties, during which only one fixed-wing aircraft and only seven aircraft in all were lost to hostile fire.15 Evidence of a comparable inequality in the military capability of belligerents will probably become available in the aftermath of the recent conflict in Lebanon. Without anticipating the more detailed analysis below, it should be noted that the Iraqi army’s widespread infringements during the international conflict against the US-led Coalition, as well as Hezbollah’s indiscriminate attacks, stem to a significant extent from the blatant inequality in weaponry. Practices employed by the Iraqi army included recourse to human shields, abuse of the red cross and red crescent emblems, the use of anti-personnel mines and the placing of military objects in protected areas such as mosques and hospitals. Clearly, there is thus an elevated risk that the militarily inferior party, unable to identify any military weaknesses of its superior opponent, may feel compelled systematically to offset the enemy’s superiority by resorting to means and methods of warfare outside the realm of international humanitarian law. At the same time the use of ‘‘unthinkable’’ tactics as well as the tactical circumvention of accepted IHL standards creates a barrier that cannot be readily overcome by military superiority alone. Apart from the ongoing hostilities in Iraq, the tactics employed by the Somali tribal leader Farah Aydid in 1993 are a good example of this. In conventional terms, his forces were no match for heavily armed and technologically sophisticated airborne US troops. However, by using primitive weapons and communication systems– which reportedly varied from cellular phones to tribal drums– and by resorting to ‘‘unthinkable’’ tactics and to ‘‘barbaric’’ acts perpetrated for the benefit of the news media, the militia convinced the leadership of the United States that despite the military backwardness of the Somali forces the price of involvement in Somalia was very high. In the course of the war against Iraq the use of cluster munitions in populated areas, as well as the alleged use of white phosphorus and the continued recourse by US and British forces to ‘‘decapitation’’ strikes that caused high numbers of civilian casualties, partly constituted indiscriminate attacks and arguably a failure to take ‘‘all feasible precautions’’ as required by IHL. There are thus apparent incentives for both sides to give increasing priority, potentially to the detriment of humanitarian considerations, to the necessities of such a kind of warfare. Patterns of non-compliance: the interplay between the principle of distinction and the principle of proportionality Recent conflict patterns suggest that militarily inferior parties, in order to evade attack by an enemy of insurmountable superiority or to level out inequalities in military power, tend in particular to instrumentalize and intentionally manipulate the principle of distinction. This manipulation may occur in different ways.18 Similarly, superior parties are likely to lower the barrier of proportionality in response to a systematic misuse of the principle of distinction and their resulting inability to tackle the enemy effectively. The following description of potential strategies that belligerents may feel compelled to adopt when faced with overwhelming odds or systematic deviations from accepted legal rules is merely intended to facilitate understanding of likely patterns of non-compliance and does not claim to be comprehensive. It is part of the very nature of asymmetric strategies that they are impossible to predict. The principle of distinction As a defensive strategy when facing a technologically superior enemy it is essential, but ever more difficult, to stay out of reach and conceal one’s presence as a combatant. Hiding in mountainous areas, caves, underground facilities and tunnels is one way. However, another means of doing so quickly and efficiently is readily available by virtue of the provisions of IHL themselves. In view of the various forms of protection accorded to civilians, assuming civilian guise is an easy way to evade the enemy and, unlike the more traditional guerrilla-style tactics of hiding underground or in inaccessible areas, it cannot be countered by the development of advanced discovery technologies. Indeed, in order to keep Coalition forces from identifying them as enemies, that is as legitimate targets, many Iraqi soldiers in the recent war reportedly quite often discarded their uniforms. This is not a prohibited tactic, as long as such practices are not used to launch an attack under the cover of protected status; according to Article 4 of the Third Geneva Convention the absence of any fixed distinctive sign recognizable at a distance merely leads to the loss of combatant status and the corresponding privileges. Still, despite its legality such a practice will, if employed as a matter of strategy, create considerable uncertainty about a person’s status and thus subtly erode the effectiveness of the fundamental and, in the words of the International Court of Justice (ICJ), intransgressible principle of distinction. Evidently the notion of distinction, that is, the legally prescribed invulnerability of certain persons and objects, can if manipulated offer manifold loopholes for the evasion of attack.22 The dividing line between legal tactics and illegitimate practices is easily crossed. The misuse of protective emblems for the concealment of military objects is a case in point, and the marking of the Ba’ath Party building in Basra with the ICRC emblem is a flagrant example of such tactics.23 To protect military objects whose nature could not be so readily concealed, weaker warring parties have repeatedly utilized the proportionality barrier: in order to manipulate the adversary’s proportionality equation, immobile military objects are shielded by civilians, while mobile military equipment is intentionally sited close to civilian installations or other specifically protected locations. For example, in the recent conflict in the Middle East Hezbollah hid its rockets and military equipment in civilian neighbourhoods, and UN UnderSecretary-General Jan Egeland’s statement clearly points to the vicious circle that might be triggered by such a practice.24 Similar modes of conduct have been employed with regard to offensive tactics. The reported seizure of ambulance vehicles in order to feign protected status and thus improve the chances of attacking is a typical example, as is the fact that during the battle of Fallujah in November 2004 sixty of the city’s one hundred mosques were reportedly used as bases for military operations.25 It should be noted that, besides violating the principle of distinction, creating the false impression of legal entitlement to immunity from attack and exploiting the enemy’s confidence in that status also amount to perfidy and are prohibited as such.26 Not each and every strategy employed to circumvent superior military power by cunning, surprise, indirect approach or ruthlessness automatically constitutes prohibited conduct; it may, depending on the circumstances, amount to no more than good tactics. However, if unable to identify any military weaknesses of a superior enemy, the weaker opponent may ultimately see no other alternative than to aim for the stronger state’s soft underbelly and attack civilians or civilian objects directly, in outright violation of the principle of distinction. The series of terrorist attacks in the aftermath of 9/11, that is, the attacks in Bali, Mombasa and Djerba in 2002, Riyadh and Casablanca in 2003, Madrid in 2004, London and Cairo in 2005 and Mumbai in 2006– to mention only those which have received the greatest media attention– and the constant attacks in Afghanistan and Iraq, shows that this tendency is increasing. Avoiding the risks of attacking well-protected military installations, it enables the weaker opponent to wage an offensive war on the television screens and in the homes of the stronger state and to benefit from the repercussive effects of mass media coverage.27 The principle of proportionality Over time there is a considerable risk that in view of the aforesaid practices, international humanitarian law itself, with its clear-cut categorizations and differentiations between military and civil, may be perceived by a belligerent confronted with repeated violations by its opponent as opening the doors to a kind of war which intentionally does away with such clear demarcations.28 However, the more immediate risk is that the adversary, faced with such a misuse of the principle of distinction, could feel compelled gradually to lower the proportionality barrier. Evidently, if the use of human shields or the concealment of military equipment among civilian facilities occurs only sporadically and at random in an armed conflict, humanitarian concerns are likely to outweigh the necessity to attack using disproportionate force, whereas if such tactics are systematically employed for a strategic purpose, the enemy may feel a compelling and overriding necessity to attack irrespective of the anticipated civilian casualties and damage. Indeed, the explanation given by the Israeli government for the mounting number of civilian casualties in its recent military operations against Hezbollah in Lebanon29 confirms that systematic violation of, for example, the principle of distinction by one side during a conflict is likely adversely to affect the other side’s interpretation and application of the proportionality principle. Military necessity in asymmetric conflicts Although the concept of military necessity is invoked now and then as a separate justification for violations of the laws of war, today there can be no doubt that in contemporary international humanitarian law the element of military necessity must be balanced against the principle of humanity, and that there is no such elasticity in the laws of war that military necessity can be claimed as a reason to deviate from accepted humanitarian standards. Nevertheless, asymmetric conflict arguably entails a certain risk of the emergence of a modern-day Kriegsrason because obstacles seen as insurmountable could make both sides feel inclined and ultimately compelled vastly to expand their perception of what is necessary to overcome the enemy. Since military necessity is a component of the ius in bello equation of proportionality, to expand or overemphasize the concept of military necessity would impair the protective scope of the proportionality principle.33 The principle of military necessity is closely linked to the objectives of war. However, the objectives sought in asymmetric conflicts vary significantly from those sought in the kind of symmetric conflict constellations which the drafting fathers of the principle of military necessity had in mind. Modern authorities on the laws of war continue to refer to the definition of military necessity laid down in Article 14 of the Lieber Code, according to which ‘‘Military necessity, as understood by modern civilized nations, consists in the necessity of those measures which are indispensable for securing the ends of the war, and which are lawful according to the modern law and usages of war.’’ In view of the formulation ‘‘indispensable for securing the ends of war’’, the principle of military necessity is commonly understood to justify only that degree of force necessary to secure military defeat and the prompt submission of the enemy.37 Indeed, the Declaration of St Petersburg states as early as 1868 that ‘‘the only legitimate object which States should endeavour to accomplish during war is to weaken the military forces of the enemy’’38 and the US Army Field Manual stipulates that ‘‘The law of war … requires that belligerents refrain from employing any kind or degree of violence which is not actually necessary for military purposes’’ and defines military necessity as ‘‘that principle which justifies those measures not forbidden by international law which are indispensable for the complete submission of the enemy as soon as possible’’. Historically, the rather strict alignment of the concept of military necessity with exclusively military objectives, that is, military defeat and the prompt military submission of the enemy, is due to the fact that the concept was originally designed to restrain violence in war. Although sometimes overlooked today, restrictions on violence in war do not merely stem from balancing the principle of military necessity against the principle of humanity.41 The principle of military necessity in and of itself constitutes an important restrictive factor by prescribing that to be legitimate, violence in war first of all has to be militarily necessary.42 A gradual, clandestine widening of this concept, or simply a more lenient understanding of the factors that determine military necessity and hence the notion of military advantage, would therefore undermine the restrictive standards imposed on the use of violence in armed conflicts. Such a process seems particularly likely in view of asymmetric constellations which, owing to their complexity and intangibility, escape any military apprehension stricto sensu. For example, application of the rule of proportionality as laid down in Articles 51 and 57 of Additional Protocol I is significantly affected, even in traditional armed conflicts, by whether the notion of military advantage is understood to mean the advantage anticipated from an attack considered as a whole or merely from isolated or particular parts of the attack.43 In asymmetric constellations that elude both temporal and spatial boundaries– in other words, the traditional concept of the ‘‘battlefield’’ altogether– it would seem somewhat difficult to delineate and determine with any degree of precision what is meant by the notion of ‘‘an attack considered as a whole’’.44 More generally, as the asymmetry between belligerents increases, the distinction between political and military objectives and necessities becomes more and more blurred. Especially in conflicts such as those against al Qaeda or Hezbollah, that is, conflicts between a state or group of states and a non-state entity, that entity’s ultimate aim in using military force will be to exert pressure on the politics of the enemy rather than even attempt to achieve the latter’s military submission. Conversely, the superior party is likely to adopt a far more holistic approach, inseparably combining political and military efforts to bring about the entire political eradication or dissolution of the enemy and not just the enemy’s military submission– especially if it is battling against a non-state entity it categorizes as a terrorist organization.45 To be sure, the separation of military and political aims already present in traditional warfare has always been axiomatic to some extent, given that each and every military operation emanates from both military and political motivations.46 The so-called Christmas bombing of North Vietnam in 1972 is a typical example: even though solely military objectives within the definition thereof were targeted, its purpose was to induce the North Vietnamese government to proceed with political negotiations. Nonetheless, symmetric warfare with its identifiable battlefields in terms of space and duration did allow, at least in theory, a relatively clear separation of military and political necessities and objectives in the actual conduct of warfare. In asymmetric scenarios, however, the weaker adversary is militarily outmatched from the start, military superiority in itself is no longer a reliable guarantee for winning such conflicts and the very notions of ‘‘victory’’ or ‘‘defeat’’ thus become more and more indistinct. If these parameters remain undefined or even indefinable, straightforward determinations of what is militarily necessary are impeded. Military necessities have always been subject to change as warfare has developed, and the concept of military necessity has been flexible enough to adapt accordingly as long as that development largely resulted from technological advances in weaponry. Yet it seems doubtful whether asymmetric constellations akin to law enforcement patterns could still be grasped by and measured against the concept of military necessity,48 for the complexities and intangibility of such scenarios escape its traditionally narrow delimitations. To compromise the concept’s very narrowness, however, would mean compromising long-achieved humanitarian protections that flow directly from the concept itself and could shift the focus of the proportionality equation away from humanitarian considerations and towards military necessities.
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You can only respond to the prompt using information in the context block.
EVIDENCE:
Abstract Inequality in arms, indeed, significant disparity between belligerents, has become a prominent feature of various contemporary armed conflicts. Such asymmetries, albeit not at all a new phenomenon in the field of warfare, no longer constitute a random occurrence of singular battles. As a structural characteristic of modern-day warfare asymmetric conflict structures have repercussions on the application of fundamental principles of international humanitarian law. How, for example, can the concept of military necessity, commonly understood to justify the degree of force necessary to secure military defeat of the enemy, be reconciled with a constellation in which one side in the conflict is from the outset bereft of any chance of winning the conflict militarily? Moreover, military imbalances of this scope evidently carry incentives for the inferior party to level out its inferiority by circumventing accepted rules of warfare. This article attempts tentatively to assess the repercussions this could have on the principle of reciprocity, especially the risk of the instigation of a destabilizing dynamic of negative reciprocity which ultimately could lead to a gradual intensification of a mutual disregard of international humanitarian law. Introduction With only one remaining superpower and more generally the considerable and predictably widening technological divide, an imbalance in the military capacity of warring parties has become a characteristic feature of contemporary armed conflicts. Coupled with a growing involvement of non-state entities, the disparity between belligerents is steadily increasing, and various contemporary armed conflicts appear to be more and more asymmetric in structure. Unlike the geostrategic set-up that prevailed throughout the cold war period, it is a widely perceived paradox of today’s strategic environment that military superiority may actually accentuate the threat of nuclear, biological, chemical and, generally speaking, perfidious attack. Indeed, direct attacks against civilians, hostage-taking and the use of human shields – practices that have long been outlawed in armed conflicts– have seen a revival in recent conflicts in which the far weaker party has often sought to gain a comparative advantage over the militarily superior enemy by resorting to such practices as a matter of strategy. International terrorism, although not necessarily conducted within the context of an armed conflict triggering the application of international humanitarian law (IHL), is often regarded as the epitome of such asymmetry. At the same time militarily superior parties at the other end of the spectrum have had recourse to indiscriminate attacks, illegal interrogation practices and renditions, as well as legally dubious practices such as targeted killings or hardly reviewable covert operations, in order to strike at their frequently amorphous enemy. Significant inequality of arms, that is a disparate distribution of military strength and technological capability in a given conflict, seemingly creates incentives for adversaries to resort to means and methods of warfare that undermine and are sometimes an outright violation of long-accepted standards of international humanitarian law. The war between the US-led Coalition and Iraq or the war in Afghanistan are clear examples. This tendency is reinforced if belligerents differ in nature, as in the recent conflict between Israel and Hezbollah (‘‘party of God’’)– the Lebanon-based Shia Islamic militia and political organization– or if factual asymmetries are combined with a legal asymmetry, that is in a constellation in which one side is accorded little or no legal standing. To be sure, perfect symmetries have rarely been present in war. However, the patterns of non-compliance displayed in various contemporary conflicts seem to be more structured and systematic than ever before. The present study first seeks to verify this assumption. It considers whether factual and potentially legal asymmetries do indeed constitute an incentive for breaches of international humanitarian law provisions, and, if so, how patterns of contemporary conflicts differ from those of previous conflicts that likewise exhibited discernible asymmetries. In a second step, closer scrutiny is given to the actual patterns of non-compliance in asymmetric scenarios, particularly in the light of the interplay of the principle of distinction and the principle of proportionality. Neither the term ‘‘asymmetric warfare’’ nor the sometimes synonymously employed terms ‘‘fourth-generation warfare’’ or ‘‘non-linear war’’ have thus far been concordantly defined.3 It is not the intention of this study to venture into this perhaps impenetrable terrain. Analysis shows, however, that there is a noticeable tendency in contemporary conflicts towards an increasing inequality between belligerents in terms of weaponry. While this is a long-known phenomenon in non-international armed conflicts, evaluation of the effects of military disparity in international armed conflicts continues, as does the debate over the extent to which transnational conflicts involving states and non-state entities should be subject to the laws of war. In attempting to approach this debate from a somewhat different angle, it is the overall purpose of this study to gauge the long-term repercussions that asymmetric conflict structures may have on the fundamental principles of international humanitarian law and thereby tentatively to assess the degree of asymmetry– that is, the level of military disparity between belligerents– that can still be reconciled with the legal regime applicable in times of war.5 To this end the study, in a third step, weighs the traditional concept of military necessity as laid down in the Lieber Code of 1863 against the promulgated necessities in asymmetric conflicts of our time. Even though the fundamental concepts and principles of the laws of war have been designed as prophylactic mechanisms flexible enough to outlast changes in the way in which wars are waged, it is here contended that the concept of military necessity and the principle of distinction presuppose a minimum degree of symmetry and therefore cannot be applied in subordinative constellations akin to human rights patterns, as are commonly seen in the fight against international terrorism. The vantage point for the fourth and final part of the analysis is the principle of reciprocity. As the military mismatch between conflicting parties in numerous modern armed conflicts becomes more marked, the balancing influence of the reciprocity entailed by the traditional concept of symmetric warfare is gradually being undermined.6 While the deterrent effects of an increasingly effective system of international criminal law and of media coverage and public opinion– although the last two are ambivalent factors that could also be used for the opposite purpose– could arguably help to contain non-compliant behaviour in war, international humanitarian law might thus be simultaneously bereft of its own inherent regulating mechanisms which have traditionally taken effect in the combat zone itself. The destabilizing dynamic of reciprocity could lead to a gradual and perhaps insidious erosion of the protective scope of core principles of international humanitarian law. Repeated violations of, for example, the principle of distinction by one party to a conflict are likely to induce the other side to expand its perception of what is militarily necessary, and hence proportional, when engaging in battle against such an enemy. In the final stage, and admittedly only as a worst-case scenario, an intentional and deceitful deviation from accepted standards regulating the conduct of hostilities carries the considerable risk of starting a vicious circle of ever greater negative reciprocity, in which the expectations of the warring parties are transformed into an escalating mutual noncompliance with international humanitarian law. A heightened risk of structural non-compliance? Historically, the majority of laws on international armed conflict have been designed on the basis of Clausewitz’s arguably rather Eurocentric conception of war, that is, the assumption of symmetric conflicts taking place between state armies of roughly equal military strength or at least comparable organizational structures. Throughout most of the nineteenth and twentieth centuries the dominant powers engaged in sustained arms races either to maintain a peace ensuring symmetry or to establish a tactical asymmetry vis-a `-vis their opponents as a guarantee of military victory in war.7 But quite apart from the biblical story of David and Goliath it is evident that asymmetry in the sense of military disparity is no new phenomenon.8 Nor is it a concept entirely alien to IHL. With the intrinsic disparity of the parties concerned, and even though the threshold criteria of Article 1 of Additional Protocol II to the 1949 Geneva Conventions arguably help to ensure a minimum degree of comparability between those parties, non-international armed conflicts are inherently asymmetric. It was moreover already accepted in the classic concept of symmetric warfare that the structure of conflicts could shift from symmetric to asymmetric, for by the time a conflict drew to its close and one party had gained the upper hand, the initial military balance would be out of kilter. More recently, during the Diplomatic Conference that led to the adoption of Additional Protocol I, states taking part not only acknowledged the persistence of significant disparities in military capacity but accepted that factual disparity between opponents may even lead to differing humanitarian law obligations. For example, with respect to Article 57 of Additional Protocol I on the obligation to take precautions in attack,9 the Indian delegation pointed out that according to the chosen wording the content of the due diligence obligation enshrined therein– that is, the precise identification of objectives as military or civilian– largely depended on the technical means of detection available to the belligerents.10 Despite these concerns, the present wording was accepted on the implicit understanding that because of prevailing factual disparities, international humanitarian law obligations may impose differing burdens in practice.11 Schwarzenberger has pointed out that the protective scope of the laws of war has historically been the strongest in duel-type wars between comparable belligerents that were fought for limited purposes, such as the Crimean War of 1853–6 or the Franco-German War of 1870–1, whereas in major wars such as the Napoleonic wars or the two world wars of the twentieth century– wars that were fought to the bitter end– the weaker side often tended to seek short-term advantages by violating the laws of war.12 Indeed, violations of the laws of war have occurred in nearly every case in which IHL has been applicable,13 and the risk that one party may order or connive in large-scale violations of the laws of war in order to gain a tempting advantage or stave off in some way an otherwise threatening defeat has always hovered over the legal regime intended to regulate conduct in armed conflicts.14 However, in symmetric constellations such instances have tended to remain marginal, often limited to the final stages of a war and confined to individual battles in which defeat seemed inevitable, or resort to perfidy or similarly prohibited tactics was perceived as guaranteeing an immediate tactical breakthrough in what was otherwise a military stalemate. As a result of the evident disparate military capabilities of opponents in certain contemporary conflicts, incentives for violations of IHL seem in comparison to have reached a new height. Non-compliance with the provisions of IHL is no longer a random event, confined to temporally and spatially limited incidents within a conflict, but has become a recurrent structural feature that characterizes many of today’s armed conflicts from the outset. The reason is that, faced with an enemy of overwhelming technological superiority, the weaker party ab initio has no chance of winning the war militarily. Figures from the recent war against Iraq illustrate this imbalance of power and capacity quite well. While the Iraqi air force reportedly never left the ground, Coalition forces flew rather more than 20,000 sorties, during which only one fixed-wing aircraft and only seven aircraft in all were lost to hostile fire.15 Evidence of a comparable inequality in the military capability of belligerents will probably become available in the aftermath of the recent conflict in Lebanon. Without anticipating the more detailed analysis below, it should be noted that the Iraqi army’s widespread infringements during the international conflict against the US-led Coalition, as well as Hezbollah’s indiscriminate attacks, stem to a significant extent from the blatant inequality in weaponry. Practices employed by the Iraqi army included recourse to human shields, abuse of the red cross and red crescent emblems, the use of anti-personnel mines and the placing of military objects in protected areas such as mosques and hospitals. Clearly, there is thus an elevated risk that the militarily inferior party, unable to identify any military weaknesses of its superior opponent, may feel compelled systematically to offset the enemy’s superiority by resorting to means and methods of warfare outside the realm of international humanitarian law. At the same time the use of ‘‘unthinkable’’ tactics as well as the tactical circumvention of accepted IHL standards creates a barrier that cannot be readily overcome by military superiority alone. Apart from the ongoing hostilities in Iraq, the tactics employed by the Somali tribal leader Farah Aydid in 1993 are a good example of this. In conventional terms, his forces were no match for heavily armed and technologically sophisticated airborne US troops. However, by using primitive weapons and communication systems– which reportedly varied from cellular phones to tribal drums– and by resorting to ‘‘unthinkable’’ tactics and to ‘‘barbaric’’ acts perpetrated for the benefit of the news media, the militia convinced the leadership of the United States that despite the military backwardness of the Somali forces the price of involvement in Somalia was very high. In the course of the war against Iraq the use of cluster munitions in populated areas, as well as the alleged use of white phosphorus and the continued recourse by US and British forces to ‘‘decapitation’’ strikes that caused high numbers of civilian casualties, partly constituted indiscriminate attacks and arguably a failure to take ‘‘all feasible precautions’’ as required by IHL. There are thus apparent incentives for both sides to give increasing priority, potentially to the detriment of humanitarian considerations, to the necessities of such a kind of warfare. Patterns of non-compliance: the interplay between the principle of distinction and the principle of proportionality Recent conflict patterns suggest that militarily inferior parties, in order to evade attack by an enemy of insurmountable superiority or to level out inequalities in military power, tend in particular to instrumentalize and intentionally manipulate the principle of distinction. This manipulation may occur in different ways.18 Similarly, superior parties are likely to lower the barrier of proportionality in response to a systematic misuse of the principle of distinction and their resulting inability to tackle the enemy effectively. The following description of potential strategies that belligerents may feel compelled to adopt when faced with overwhelming odds or systematic deviations from accepted legal rules is merely intended to facilitate understanding of likely patterns of non-compliance and does not claim to be comprehensive. It is part of the very nature of asymmetric strategies that they are impossible to predict. The principle of distinction As a defensive strategy when facing a technologically superior enemy it is essential, but ever more difficult, to stay out of reach and conceal one’s presence as a combatant. Hiding in mountainous areas, caves, underground facilities and tunnels is one way. However, another means of doing so quickly and efficiently is readily available by virtue of the provisions of IHL themselves. In view of the various forms of protection accorded to civilians, assuming civilian guise is an easy way to evade the enemy and, unlike the more traditional guerrilla-style tactics of hiding underground or in inaccessible areas, it cannot be countered by the development of advanced discovery technologies. Indeed, in order to keep Coalition forces from identifying them as enemies, that is as legitimate targets, many Iraqi soldiers in the recent war reportedly quite often discarded their uniforms. This is not a prohibited tactic, as long as such practices are not used to launch an attack under the cover of protected status; according to Article 4 of the Third Geneva Convention the absence of any fixed distinctive sign recognizable at a distance merely leads to the loss of combatant status and the corresponding privileges. Still, despite its legality such a practice will, if employed as a matter of strategy, create considerable uncertainty about a person’s status and thus subtly erode the effectiveness of the fundamental and, in the words of the International Court of Justice (ICJ), intransgressible principle of distinction. Evidently the notion of distinction, that is, the legally prescribed invulnerability of certain persons and objects, can if manipulated offer manifold loopholes for the evasion of attack.22 The dividing line between legal tactics and illegitimate practices is easily crossed. The misuse of protective emblems for the concealment of military objects is a case in point, and the marking of the Ba’ath Party building in Basra with the ICRC emblem is a flagrant example of such tactics.23 To protect military objects whose nature could not be so readily concealed, weaker warring parties have repeatedly utilized the proportionality barrier: in order to manipulate the adversary’s proportionality equation, immobile military objects are shielded by civilians, while mobile military equipment is intentionally sited close to civilian installations or other specifically protected locations. For example, in the recent conflict in the Middle East Hezbollah hid its rockets and military equipment in civilian neighbourhoods, and UN UnderSecretary-General Jan Egeland’s statement clearly points to the vicious circle that might be triggered by such a practice.24 Similar modes of conduct have been employed with regard to offensive tactics. The reported seizure of ambulance vehicles in order to feign protected status and thus improve the chances of attacking is a typical example, as is the fact that during the battle of Fallujah in November 2004 sixty of the city’s one hundred mosques were reportedly used as bases for military operations.25 It should be noted that, besides violating the principle of distinction, creating the false impression of legal entitlement to immunity from attack and exploiting the enemy’s confidence in that status also amount to perfidy and are prohibited as such.26 Not each and every strategy employed to circumvent superior military power by cunning, surprise, indirect approach or ruthlessness automatically constitutes prohibited conduct; it may, depending on the circumstances, amount to no more than good tactics. However, if unable to identify any military weaknesses of a superior enemy, the weaker opponent may ultimately see no other alternative than to aim for the stronger state’s soft underbelly and attack civilians or civilian objects directly, in outright violation of the principle of distinction. The series of terrorist attacks in the aftermath of 9/11, that is, the attacks in Bali, Mombasa and Djerba in 2002, Riyadh and Casablanca in 2003, Madrid in 2004, London and Cairo in 2005 and Mumbai in 2006– to mention only those which have received the greatest media attention– and the constant attacks in Afghanistan and Iraq, shows that this tendency is increasing. Avoiding the risks of attacking well-protected military installations, it enables the weaker opponent to wage an offensive war on the television screens and in the homes of the stronger state and to benefit from the repercussive effects of mass media coverage.27 The principle of proportionality Over time there is a considerable risk that in view of the aforesaid practices, international humanitarian law itself, with its clear-cut categorizations and differentiations between military and civil, may be perceived by a belligerent confronted with repeated violations by its opponent as opening the doors to a kind of war which intentionally does away with such clear demarcations.28 However, the more immediate risk is that the adversary, faced with such a misuse of the principle of distinction, could feel compelled gradually to lower the proportionality barrier. Evidently, if the use of human shields or the concealment of military equipment among civilian facilities occurs only sporadically and at random in an armed conflict, humanitarian concerns are likely to outweigh the necessity to attack using disproportionate force, whereas if such tactics are systematically employed for a strategic purpose, the enemy may feel a compelling and overriding necessity to attack irrespective of the anticipated civilian casualties and damage. Indeed, the explanation given by the Israeli government for the mounting number of civilian casualties in its recent military operations against Hezbollah in Lebanon29 confirms that systematic violation of, for example, the principle of distinction by one side during a conflict is likely adversely to affect the other side’s interpretation and application of the proportionality principle. Military necessity in asymmetric conflicts Although the concept of military necessity is invoked now and then as a separate justification for violations of the laws of war, today there can be no doubt that in contemporary international humanitarian law the element of military necessity must be balanced against the principle of humanity, and that there is no such elasticity in the laws of war that military necessity can be claimed as a reason to deviate from accepted humanitarian standards. Nevertheless, asymmetric conflict arguably entails a certain risk of the emergence of a modern-day Kriegsrason because obstacles seen as insurmountable could make both sides feel inclined and ultimately compelled vastly to expand their perception of what is necessary to overcome the enemy. Since military necessity is a component of the ius in bello equation of proportionality, to expand or overemphasize the concept of military necessity would impair the protective scope of the proportionality principle.33 The principle of military necessity is closely linked to the objectives of war. However, the objectives sought in asymmetric conflicts vary significantly from those sought in the kind of symmetric conflict constellations which the drafting fathers of the principle of military necessity had in mind. Modern authorities on the laws of war continue to refer to the definition of military necessity laid down in Article 14 of the Lieber Code, according to which ‘‘Military necessity, as understood by modern civilized nations, consists in the necessity of those measures which are indispensable for securing the ends of the war, and which are lawful according to the modern law and usages of war.’’ In view of the formulation ‘‘indispensable for securing the ends of war’’, the principle of military necessity is commonly understood to justify only that degree of force necessary to secure military defeat and the prompt submission of the enemy.37 Indeed, the Declaration of St Petersburg states as early as 1868 that ‘‘the only legitimate object which States should endeavour to accomplish during war is to weaken the military forces of the enemy’’38 and the US Army Field Manual stipulates that ‘‘The law of war … requires that belligerents refrain from employing any kind or degree of violence which is not actually necessary for military purposes’’ and defines military necessity as ‘‘that principle which justifies those measures not forbidden by international law which are indispensable for the complete submission of the enemy as soon as possible’’. Historically, the rather strict alignment of the concept of military necessity with exclusively military objectives, that is, military defeat and the prompt military submission of the enemy, is due to the fact that the concept was originally designed to restrain violence in war. Although sometimes overlooked today, restrictions on violence in war do not merely stem from balancing the principle of military necessity against the principle of humanity.41 The principle of military necessity in and of itself constitutes an important restrictive factor by prescribing that to be legitimate, violence in war first of all has to be militarily necessary.42 A gradual, clandestine widening of this concept, or simply a more lenient understanding of the factors that determine military necessity and hence the notion of military advantage, would therefore undermine the restrictive standards imposed on the use of violence in armed conflicts. Such a process seems particularly likely in view of asymmetric constellations which, owing to their complexity and intangibility, escape any military apprehension stricto sensu. For example, application of the rule of proportionality as laid down in Articles 51 and 57 of Additional Protocol I is significantly affected, even in traditional armed conflicts, by whether the notion of military advantage is understood to mean the advantage anticipated from an attack considered as a whole or merely from isolated or particular parts of the attack.43 In asymmetric constellations that elude both temporal and spatial boundaries– in other words, the traditional concept of the ‘‘battlefield’’ altogether– it would seem somewhat difficult to delineate and determine with any degree of precision what is meant by the notion of ‘‘an attack considered as a whole’’.44 More generally, as the asymmetry between belligerents increases, the distinction between political and military objectives and necessities becomes more and more blurred. Especially in conflicts such as those against al Qaeda or Hezbollah, that is, conflicts between a state or group of states and a non-state entity, that entity’s ultimate aim in using military force will be to exert pressure on the politics of the enemy rather than even attempt to achieve the latter’s military submission. Conversely, the superior party is likely to adopt a far more holistic approach, inseparably combining political and military efforts to bring about the entire political eradication or dissolution of the enemy and not just the enemy’s military submission– especially if it is battling against a non-state entity it categorizes as a terrorist organization.45 To be sure, the separation of military and political aims already present in traditional warfare has always been axiomatic to some extent, given that each and every military operation emanates from both military and political motivations.46 The so-called Christmas bombing of North Vietnam in 1972 is a typical example: even though solely military objectives within the definition thereof were targeted, its purpose was to induce the North Vietnamese government to proceed with political negotiations. Nonetheless, symmetric warfare with its identifiable battlefields in terms of space and duration did allow, at least in theory, a relatively clear separation of military and political necessities and objectives in the actual conduct of warfare. In asymmetric scenarios, however, the weaker adversary is militarily outmatched from the start, military superiority in itself is no longer a reliable guarantee for winning such conflicts and the very notions of ‘‘victory’’ or ‘‘defeat’’ thus become more and more indistinct. If these parameters remain undefined or even indefinable, straightforward determinations of what is militarily necessary are impeded. Military necessities have always been subject to change as warfare has developed, and the concept of military necessity has been flexible enough to adapt accordingly as long as that development largely resulted from technological advances in weaponry. Yet it seems doubtful whether asymmetric constellations akin to law enforcement patterns could still be grasped by and measured against the concept of military necessity,48 for the complexities and intangibility of such scenarios escape its traditionally narrow delimitations. To compromise the concept’s very narrowness, however, would mean compromising long-achieved humanitarian protections that flow directly from the concept itself and could shift the focus of the proportionality equation away from humanitarian considerations and towards military necessities.
USER:
Discuss the concept of military necessity as outlined in this article and its relationship to contemporary asymmetric conflict.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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What are the different minerals in seawater which affect performance, what is causing the decrease in performance and how can we prevent performance degradation from occurring.
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INTRODUCTION Hydrogen (H2), with its high-energy density and zero-emission properties, holds great promise as a sustainable energy carrier (1–4). Seawater electrolysis, as a promising alternative for sustainable hydrogen production, faces challenges due to the expensive and scarce platinum catalyst, as well as the need for additional purification processes to address the complex nature of seawater, resulting in higher production costs (5–7). Compared to the widely adopted practice of hydrogen production through electrolysis of alkaline freshwater, the advancement of hydrogen production from seawater has been relatively sluggish (8). The pH of natural seawater is typically around 8.0 and reduced ionic mobility in seawater leads to a diminished pH dependence of the hydrogen evolution reaction (HER) (9, 10), necessitating higher applied voltages to attain the desired efficiency in hydrogen production (11). Furthermore, the complex composition of seawater and the insoluble deposits formed by alkaline earth metal ions such as Ca2+, Mg2+ during electrolysis make seawater HER challenging (1, 12). More fatally, Cl- has a high affinity for the metal active sites of the catalysts as they have strong depassivation and penetrating properties (13, 14), leading to severe degradation of the catalyst and hindering direct seawater electrolysis for hydrogen production (15–17). Although certain catalysts demonstrated activity at low current densities but offer low hydrogen production rates (18, 19), far below the high-current hydrogen production conditions required for industrial water electrolysis. To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts. RESULTS Synthesis and characterization The hydrothermal method was used to prepare hydroxide precursors in nanoflower-shaped structures, as illustrated in figs. S1 and S2. Subsequently, calcination in NH3 gas was used to obtain a composite of Ni3N and V2O3, resulting in the formation of numerous rough porous structures on the catalyst surface. Pt-Ni3N@V2O3/NF (nickel foam noted as NF) was constructed by placing the Ni3N@V2O3/NF precursor in an aqueous solution of H2PtCl6 at room temperature. On the basis of previous reports, we speculate on the reduction mechanism and route (30–32). Specifically, V2O3, as a strong reducing agent, first forms (V2O3)x(OH-)y(s) with H2O molecules (chemical eq. S1), and then Pt4+ ions in solution adsorb onto the surface of the (V2O3)x(OH-)y(s). In situ reduction then occurs with the assistance of H2O molecules to form Pt nanoparticles (chemical eq. S2). Theoretical calculations also confirm that Pt nanoparticles preferentially form on the V2O3 surface rather than the Ni3N surface (fig. S2). The powder x-ray diffraction (XRD) patterns, as illustrated in Fig. 1A and fig. S3, confirm the presence of a composite phase comprising Ni3N, V2O3, and Pt. These results demonstrate the successful preparation of Pt-Ni3N@V2O3/NF. The hydroxide precursors prepared by the hydrothermal method exhibited nanoflower-like structures with low crystallinity, as shown in figs. S4 and S5. After ammonolysis, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) show that Ni3N@V2O3/NF exhibit interconnected porous structures (fig. S6) with lattice stripes of 0.203 and 0.183 nm corresponding well to the (111) and (024) facets of Ni3N and V2O3 (fig. S7), respectively. After the incorporation of Pt, SEM and TEM analyses reveal that Pt-Ni3N@V2O3/NF exhibits a granular morphology, together with a rough surface (Fig. 1, B and C). Pt nanoparticles, formed in situ, have an average particle size of 4.41 nm. The high-resolution TEM (HRTEM) shows that amorphous/low crystallinity V2O3 covers the outer surface of Pt-Ni3N@V2O3/NF (Fig. 1D), with lattice stripes of 0.203 and 0.226 nm corresponding to the (111) facets of Ni3N and the (111) facets of Pt (Fig. 1, E to G), respectively. As demonstrated in fig. S8, the particle size of Pt-Ni3N@V2O3/NF increases with longer impregnation time, and this observation is also supported by the electrochemical properties. In Fig. 1 (H and I), high-angle annular dark-field scanning TEM (HAADF-STEM) images, energy-dispersive spectroscopy (EDS) elemental mapping, and EDS line scan collectively suggest that the internal larger nanoparticles comprise Ni3N, while V2O3 is distributed in the surrounding region. In addition, uniformly anchored, small-sized Pt nanoparticles are found on the surface of the structure, forming a dual-active site. The content of Pt is determined by energy dispersive x-ray spectroscopy to be approximately 6.61% (fig. S9 and table S1), which is consistent with the results of inductively coupled plasma–optical emission spectrometry (ICP-OES) analysis (6.94%). It is worth noting that the reduction of Pt also occurs on the Ni3N surface in the absence of the V2O3 in situ reduction layer (fig. S3C), but with considerable agglomeration (figs. S10 and S11), which is undoubtedly detrimental to catalytic performance. The V2O3 serves as both a potent in situ reducing agent and stabilizer. Its rough surface offers numerous anchor sites and exerts steric hindrance effects, influencing the nucleation and growth kinetics of Pt nanoparticles while impeding their migration and aggregation (30).To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts
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"================ <TEXT PASSAGE> ======= INTRODUCTION Hydrogen (H2), with its high-energy density and zero-emission properties, holds great promise as a sustainable energy carrier (1–4). Seawater electrolysis, as a promising alternative for sustainable hydrogen production, faces challenges due to the expensive and scarce platinum catalyst, as well as the need for additional purification processes to address the complex nature of seawater, resulting in higher production costs (5–7). Compared to the widely adopted practice of hydrogen production through electrolysis of alkaline freshwater, the advancement of hydrogen production from seawater has been relatively sluggish (8). The pH of natural seawater is typically around 8.0 and reduced ionic mobility in seawater leads to a diminished pH dependence of the hydrogen evolution reaction (HER) (9, 10), necessitating higher applied voltages to attain the desired efficiency in hydrogen production (11). Furthermore, the complex composition of seawater and the insoluble deposits formed by alkaline earth metal ions such as Ca2+, Mg2+ during electrolysis make seawater HER challenging (1, 12). More fatally, Cl- has a high affinity for the metal active sites of the catalysts as they have strong depassivation and penetrating properties (13, 14), leading to severe degradation of the catalyst and hindering direct seawater electrolysis for hydrogen production (15–17). Although certain catalysts demonstrated activity at low current densities but offer low hydrogen production rates (18, 19), far below the high-current hydrogen production conditions required for industrial water electrolysis. To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts. RESULTS Synthesis and characterization The hydrothermal method was used to prepare hydroxide precursors in nanoflower-shaped structures, as illustrated in figs. S1 and S2. Subsequently, calcination in NH3 gas was used to obtain a composite of Ni3N and V2O3, resulting in the formation of numerous rough porous structures on the catalyst surface. Pt-Ni3N@V2O3/NF (nickel foam noted as NF) was constructed by placing the Ni3N@V2O3/NF precursor in an aqueous solution of H2PtCl6 at room temperature. On the basis of previous reports, we speculate on the reduction mechanism and route (30–32). Specifically, V2O3, as a strong reducing agent, first forms (V2O3)x(OH-)y(s) with H2O molecules (chemical eq. S1), and then Pt4+ ions in solution adsorb onto the surface of the (V2O3)x(OH-)y(s). In situ reduction then occurs with the assistance of H2O molecules to form Pt nanoparticles (chemical eq. S2). Theoretical calculations also confirm that Pt nanoparticles preferentially form on the V2O3 surface rather than the Ni3N surface (fig. S2). The powder x-ray diffraction (XRD) patterns, as illustrated in Fig. 1A and fig. S3, confirm the presence of a composite phase comprising Ni3N, V2O3, and Pt. These results demonstrate the successful preparation of Pt-Ni3N@V2O3/NF. The hydroxide precursors prepared by the hydrothermal method exhibited nanoflower-like structures with low crystallinity, as shown in figs. S4 and S5. After ammonolysis, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) show that Ni3N@V2O3/NF exhibit interconnected porous structures (fig. S6) with lattice stripes of 0.203 and 0.183 nm corresponding well to the (111) and (024) facets of Ni3N and V2O3 (fig. S7), respectively. After the incorporation of Pt, SEM and TEM analyses reveal that Pt-Ni3N@V2O3/NF exhibits a granular morphology, together with a rough surface (Fig. 1, B and C). Pt nanoparticles, formed in situ, have an average particle size of 4.41 nm. The high-resolution TEM (HRTEM) shows that amorphous/low crystallinity V2O3 covers the outer surface of Pt-Ni3N@V2O3/NF (Fig. 1D), with lattice stripes of 0.203 and 0.226 nm corresponding to the (111) facets of Ni3N and the (111) facets of Pt (Fig. 1, E to G), respectively. As demonstrated in fig. S8, the particle size of Pt-Ni3N@V2O3/NF increases with longer impregnation time, and this observation is also supported by the electrochemical properties. In Fig. 1 (H and I), high-angle annular dark-field scanning TEM (HAADF-STEM) images, energy-dispersive spectroscopy (EDS) elemental mapping, and EDS line scan collectively suggest that the internal larger nanoparticles comprise Ni3N, while V2O3 is distributed in the surrounding region. In addition, uniformly anchored, small-sized Pt nanoparticles are found on the surface of the structure, forming a dual-active site. The content of Pt is determined by energy dispersive x-ray spectroscopy to be approximately 6.61% (fig. S9 and table S1), which is consistent with the results of inductively coupled plasma–optical emission spectrometry (ICP-OES) analysis (6.94%). It is worth noting that the reduction of Pt also occurs on the Ni3N surface in the absence of the V2O3 in situ reduction layer (fig. S3C), but with considerable agglomeration (figs. S10 and S11), which is undoubtedly detrimental to catalytic performance. The V2O3 serves as both a potent in situ reducing agent and stabilizer. Its rough surface offers numerous anchor sites and exerts steric hindrance effects, influencing the nucleation and growth kinetics of Pt nanoparticles while impeding their migration and aggregation (30).To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts https://www.science.org/doi/10.1126/sciadv.adn7012 ================ <QUESTION> ======= What are the different minerals in seawater which affect performance, what is causing the decrease in performance and how can we prevent performance degradation from occurring. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
INTRODUCTION Hydrogen (H2), with its high-energy density and zero-emission properties, holds great promise as a sustainable energy carrier (1–4). Seawater electrolysis, as a promising alternative for sustainable hydrogen production, faces challenges due to the expensive and scarce platinum catalyst, as well as the need for additional purification processes to address the complex nature of seawater, resulting in higher production costs (5–7). Compared to the widely adopted practice of hydrogen production through electrolysis of alkaline freshwater, the advancement of hydrogen production from seawater has been relatively sluggish (8). The pH of natural seawater is typically around 8.0 and reduced ionic mobility in seawater leads to a diminished pH dependence of the hydrogen evolution reaction (HER) (9, 10), necessitating higher applied voltages to attain the desired efficiency in hydrogen production (11). Furthermore, the complex composition of seawater and the insoluble deposits formed by alkaline earth metal ions such as Ca2+, Mg2+ during electrolysis make seawater HER challenging (1, 12). More fatally, Cl- has a high affinity for the metal active sites of the catalysts as they have strong depassivation and penetrating properties (13, 14), leading to severe degradation of the catalyst and hindering direct seawater electrolysis for hydrogen production (15–17). Although certain catalysts demonstrated activity at low current densities but offer low hydrogen production rates (18, 19), far below the high-current hydrogen production conditions required for industrial water electrolysis. To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts. RESULTS Synthesis and characterization The hydrothermal method was used to prepare hydroxide precursors in nanoflower-shaped structures, as illustrated in figs. S1 and S2. Subsequently, calcination in NH3 gas was used to obtain a composite of Ni3N and V2O3, resulting in the formation of numerous rough porous structures on the catalyst surface. Pt-Ni3N@V2O3/NF (nickel foam noted as NF) was constructed by placing the Ni3N@V2O3/NF precursor in an aqueous solution of H2PtCl6 at room temperature. On the basis of previous reports, we speculate on the reduction mechanism and route (30–32). Specifically, V2O3, as a strong reducing agent, first forms (V2O3)x(OH-)y(s) with H2O molecules (chemical eq. S1), and then Pt4+ ions in solution adsorb onto the surface of the (V2O3)x(OH-)y(s). In situ reduction then occurs with the assistance of H2O molecules to form Pt nanoparticles (chemical eq. S2). Theoretical calculations also confirm that Pt nanoparticles preferentially form on the V2O3 surface rather than the Ni3N surface (fig. S2). The powder x-ray diffraction (XRD) patterns, as illustrated in Fig. 1A and fig. S3, confirm the presence of a composite phase comprising Ni3N, V2O3, and Pt. These results demonstrate the successful preparation of Pt-Ni3N@V2O3/NF. The hydroxide precursors prepared by the hydrothermal method exhibited nanoflower-like structures with low crystallinity, as shown in figs. S4 and S5. After ammonolysis, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) show that Ni3N@V2O3/NF exhibit interconnected porous structures (fig. S6) with lattice stripes of 0.203 and 0.183 nm corresponding well to the (111) and (024) facets of Ni3N and V2O3 (fig. S7), respectively. After the incorporation of Pt, SEM and TEM analyses reveal that Pt-Ni3N@V2O3/NF exhibits a granular morphology, together with a rough surface (Fig. 1, B and C). Pt nanoparticles, formed in situ, have an average particle size of 4.41 nm. The high-resolution TEM (HRTEM) shows that amorphous/low crystallinity V2O3 covers the outer surface of Pt-Ni3N@V2O3/NF (Fig. 1D), with lattice stripes of 0.203 and 0.226 nm corresponding to the (111) facets of Ni3N and the (111) facets of Pt (Fig. 1, E to G), respectively. As demonstrated in fig. S8, the particle size of Pt-Ni3N@V2O3/NF increases with longer impregnation time, and this observation is also supported by the electrochemical properties. In Fig. 1 (H and I), high-angle annular dark-field scanning TEM (HAADF-STEM) images, energy-dispersive spectroscopy (EDS) elemental mapping, and EDS line scan collectively suggest that the internal larger nanoparticles comprise Ni3N, while V2O3 is distributed in the surrounding region. In addition, uniformly anchored, small-sized Pt nanoparticles are found on the surface of the structure, forming a dual-active site. The content of Pt is determined by energy dispersive x-ray spectroscopy to be approximately 6.61% (fig. S9 and table S1), which is consistent with the results of inductively coupled plasma–optical emission spectrometry (ICP-OES) analysis (6.94%). It is worth noting that the reduction of Pt also occurs on the Ni3N surface in the absence of the V2O3 in situ reduction layer (fig. S3C), but with considerable agglomeration (figs. S10 and S11), which is undoubtedly detrimental to catalytic performance. The V2O3 serves as both a potent in situ reducing agent and stabilizer. Its rough surface offers numerous anchor sites and exerts steric hindrance effects, influencing the nucleation and growth kinetics of Pt nanoparticles while impeding their migration and aggregation (30).To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts
USER:
What are the different minerals in seawater which affect performance, what is causing the decrease in performance and how can we prevent performance degradation from occurring.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 26 | 1,273 | null | 409 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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I'm writing a blog post, can you please make it at least 400 words? In what ways can the use of social media foster positive psychological outcomes, such as enhanced social support, improved self-expression, and access to mental health resources, particularly when considering the role of online communities, peer feedback, and the balance between virtual and real-world interactions?
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What is healthy vs. potentially problematic social media use? Our study has brought preliminary evidence to answer this question. Using a nationally representative sample, we assessed the association of two dimensions of social media use—how much it’s routinely used and how emotionally connected users are to the platforms—with three health-related outcomes: social well-being, positive mental health, and self-rated health. We found that routine social media use—for example, using social media as part of everyday routine and responding to content that others share—is positively associated with all three health outcomes. Emotional connection to social media—for example, checking apps excessively out of fear of missing out, being disappointed about or feeling disconnected from friends when not logged into social media—is negatively associated with all three outcomes. In more general terms, these findings suggest that as long as we are mindful users, routine use may not in itself be a problem. Indeed, it could be beneficial. For those with unhealthy social media use, behavioral interventions may help. For example, programs that develop “effortful control” skills—the ability to self-regulate behavior—have been widely shown to be useful in dealing with problematic Internet and social media use. We’re used to hearing that social media use is harmful to mental health and well-being, particularly for young people. Did it surprise you to find that it can have positive effects? The findings go against what some might expect, which is intriguing. We know that having a strong social network is associated with positive mental health and well-being. Routine social media use may compensate for diminishing face-to-face social interactions in people’s busy lives. Social media may provide individuals with a platform that overcomes barriers of distance and time, allowing them to connect and reconnect with others and thereby expand and strengthen their in-person networks and interactions. Indeed, there is some empirical evidence supporting this. On the other hand, a growing body of research has demonstrated that social media use is negatively associated with mental health and well-being, particularly among young people—for example, it may contribute to increased risk of depression and anxiety symptoms. Our findings suggest that the ways that people are using social media may have more of an impact on their mental health and well-being than just the frequency and duration of their use. What disparities did you find in the ways that social media use benefits and harms certain populations? What concerns does this raise? My co-authors Rachel McCloud, Vish Viswanath, and I found that the benefits and harms associated with social media use varied across demographic, socioeconomic, and racial population sub-groups. Specifically, while the benefits were generally associated with younger age, better education, and being white, the harms were associated with older age, less education, and being a racial minority. Indeed, these findings are consistent with the body of work on communication inequalities and health disparities that our lab, the Viswanath lab, has documented over the past 15 or so years. We know that education, income, race, and ethnicity influence people’s access to, and ability to act on, health information from media, including the Internet. The concern is that social media may perpetuate those differences. — Amy Roeder
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[question] I'm writing a blog post, can you please make it at least 400 words? In what ways can the use of social media foster positive psychological outcomes, such as enhanced social support, improved self-expression, and access to mental health resources, particularly when considering the role of online communities, peer feedback, and the balance between virtual and real-world interactions? ===================== [text] What is healthy vs. potentially problematic social media use? Our study has brought preliminary evidence to answer this question. Using a nationally representative sample, we assessed the association of two dimensions of social media use—how much it’s routinely used and how emotionally connected users are to the platforms—with three health-related outcomes: social well-being, positive mental health, and self-rated health. We found that routine social media use—for example, using social media as part of everyday routine and responding to content that others share—is positively associated with all three health outcomes. Emotional connection to social media—for example, checking apps excessively out of fear of missing out, being disappointed about or feeling disconnected from friends when not logged into social media—is negatively associated with all three outcomes. In more general terms, these findings suggest that as long as we are mindful users, routine use may not in itself be a problem. Indeed, it could be beneficial. For those with unhealthy social media use, behavioral interventions may help. For example, programs that develop “effortful control” skills—the ability to self-regulate behavior—have been widely shown to be useful in dealing with problematic Internet and social media use. We’re used to hearing that social media use is harmful to mental health and well-being, particularly for young people. Did it surprise you to find that it can have positive effects? The findings go against what some might expect, which is intriguing. We know that having a strong social network is associated with positive mental health and well-being. Routine social media use may compensate for diminishing face-to-face social interactions in people’s busy lives. Social media may provide individuals with a platform that overcomes barriers of distance and time, allowing them to connect and reconnect with others and thereby expand and strengthen their in-person networks and interactions. Indeed, there is some empirical evidence supporting this. On the other hand, a growing body of research has demonstrated that social media use is negatively associated with mental health and well-being, particularly among young people—for example, it may contribute to increased risk of depression and anxiety symptoms. Our findings suggest that the ways that people are using social media may have more of an impact on their mental health and well-being than just the frequency and duration of their use. What disparities did you find in the ways that social media use benefits and harms certain populations? What concerns does this raise? My co-authors Rachel McCloud, Vish Viswanath, and I found that the benefits and harms associated with social media use varied across demographic, socioeconomic, and racial population sub-groups. Specifically, while the benefits were generally associated with younger age, better education, and being white, the harms were associated with older age, less education, and being a racial minority. Indeed, these findings are consistent with the body of work on communication inequalities and health disparities that our lab, the Viswanath lab, has documented over the past 15 or so years. We know that education, income, race, and ethnicity influence people’s access to, and ability to act on, health information from media, including the Internet. The concern is that social media may perpetuate those differences. — Amy Roeder https://www.hsph.harvard.edu/news/features/social-media-positive-mental-health/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
What is healthy vs. potentially problematic social media use? Our study has brought preliminary evidence to answer this question. Using a nationally representative sample, we assessed the association of two dimensions of social media use—how much it’s routinely used and how emotionally connected users are to the platforms—with three health-related outcomes: social well-being, positive mental health, and self-rated health. We found that routine social media use—for example, using social media as part of everyday routine and responding to content that others share—is positively associated with all three health outcomes. Emotional connection to social media—for example, checking apps excessively out of fear of missing out, being disappointed about or feeling disconnected from friends when not logged into social media—is negatively associated with all three outcomes. In more general terms, these findings suggest that as long as we are mindful users, routine use may not in itself be a problem. Indeed, it could be beneficial. For those with unhealthy social media use, behavioral interventions may help. For example, programs that develop “effortful control” skills—the ability to self-regulate behavior—have been widely shown to be useful in dealing with problematic Internet and social media use. We’re used to hearing that social media use is harmful to mental health and well-being, particularly for young people. Did it surprise you to find that it can have positive effects? The findings go against what some might expect, which is intriguing. We know that having a strong social network is associated with positive mental health and well-being. Routine social media use may compensate for diminishing face-to-face social interactions in people’s busy lives. Social media may provide individuals with a platform that overcomes barriers of distance and time, allowing them to connect and reconnect with others and thereby expand and strengthen their in-person networks and interactions. Indeed, there is some empirical evidence supporting this. On the other hand, a growing body of research has demonstrated that social media use is negatively associated with mental health and well-being, particularly among young people—for example, it may contribute to increased risk of depression and anxiety symptoms. Our findings suggest that the ways that people are using social media may have more of an impact on their mental health and well-being than just the frequency and duration of their use. What disparities did you find in the ways that social media use benefits and harms certain populations? What concerns does this raise? My co-authors Rachel McCloud, Vish Viswanath, and I found that the benefits and harms associated with social media use varied across demographic, socioeconomic, and racial population sub-groups. Specifically, while the benefits were generally associated with younger age, better education, and being white, the harms were associated with older age, less education, and being a racial minority. Indeed, these findings are consistent with the body of work on communication inequalities and health disparities that our lab, the Viswanath lab, has documented over the past 15 or so years. We know that education, income, race, and ethnicity influence people’s access to, and ability to act on, health information from media, including the Internet. The concern is that social media may perpetuate those differences. — Amy Roeder
USER:
I'm writing a blog post, can you please make it at least 400 words? In what ways can the use of social media foster positive psychological outcomes, such as enhanced social support, improved self-expression, and access to mental health resources, particularly when considering the role of online communities, peer feedback, and the balance between virtual and real-world interactions?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 58 | 523 | null | 708 |
Your response must solely be based on the prompt. External resources and prior knowledge must not be used.
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Summarize this.
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On March 18, 2022, the Department of Justice (DOJ), the agency mainly charged with enforcing the ADA, issued nonbinding web accessibility guidance for public accommodations (covered under ADA’sTitle III) and local governments (under ADA’s Title II). The guidance addresses, among other things, how public accommodations can make accessible the goods and services they offer online, although it does not provide detailed standards. The guidance offers a one-page summary of how to make a website accessible, emphasizing website providers’ “flexibility in how they comply.” WCAG and the federal government's Section 508 rules for its own websites are cited as “helpful guidance.” The limited 2022 guidance contrasts with the DOJ’s efforts in years past. In 2010, DOJ published an Advance Notice of Proposed Rulemaking providing detailed standards for website accessibility. Then, in 2017, it withdrew its regulatory proposals for websites, stating that it was “evaluating whether promulgating regulations about the accessibility of Web information and services is necessary and appropriate.” Aside from referring to WCAG and Section 508 guidelines, the 2022 DOJ guidance lists specific accessibility features web providers must consider. These include color contrast in text; text alternatives(descriptions of visual features that a screen reader can announce); captions for visual access to audio content; labels and other formatting for online forms; keyboard navigation; and a way to report accessibility issues. The DOJ guidance emphasizes that its summary “is not a complete list of things to consider.” And especially when it comes to
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Your response must solely be based on the prompt. External resources and prior knowledge must not be used. Summarize this. On March 18, 2022, the Department of Justice (DOJ), the agency mainly charged with enforcing the ADA, issued nonbinding web accessibility guidance for public accommodations (covered under ADA’sTitle III) and local governments (under ADA’s Title II). The guidance addresses, among other things, how public accommodations can make accessible the goods and services they offer online, although it does not provide detailed standards. The guidance offers a one-page summary of how to make a website accessible, emphasizing website providers’ “flexibility in how they comply.” WCAG and the federal government's Section 508 rules for its own websites are cited as “helpful guidance.” The limited 2022 guidance contrasts with the DOJ’s efforts in years past. In 2010, DOJ published an Advance Notice of Proposed Rulemaking providing detailed standards for website accessibility. Then, in 2017, it withdrew its regulatory proposals for websites, stating that it was “evaluating whether promulgating regulations about the accessibility of Web information and services is necessary and appropriate.” Aside from referring to WCAG and Section 508 guidelines, the 2022 DOJ guidance lists specific accessibility features web providers must consider. These include color contrast in text; text alternatives(descriptions of visual features that a screen reader can announce); captions for visual access to audio content; labels and other formatting for online forms; keyboard navigation; and a way to report accessibility issues. The DOJ guidance emphasizes that its summary “is not a complete list of things to consider.” And especially when it comes to
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Your response must solely be based on the prompt. External resources and prior knowledge must not be used.
EVIDENCE:
On March 18, 2022, the Department of Justice (DOJ), the agency mainly charged with enforcing the ADA, issued nonbinding web accessibility guidance for public accommodations (covered under ADA’sTitle III) and local governments (under ADA’s Title II). The guidance addresses, among other things, how public accommodations can make accessible the goods and services they offer online, although it does not provide detailed standards. The guidance offers a one-page summary of how to make a website accessible, emphasizing website providers’ “flexibility in how they comply.” WCAG and the federal government's Section 508 rules for its own websites are cited as “helpful guidance.” The limited 2022 guidance contrasts with the DOJ’s efforts in years past. In 2010, DOJ published an Advance Notice of Proposed Rulemaking providing detailed standards for website accessibility. Then, in 2017, it withdrew its regulatory proposals for websites, stating that it was “evaluating whether promulgating regulations about the accessibility of Web information and services is necessary and appropriate.” Aside from referring to WCAG and Section 508 guidelines, the 2022 DOJ guidance lists specific accessibility features web providers must consider. These include color contrast in text; text alternatives(descriptions of visual features that a screen reader can announce); captions for visual access to audio content; labels and other formatting for online forms; keyboard navigation; and a way to report accessibility issues. The DOJ guidance emphasizes that its summary “is not a complete list of things to consider.” And especially when it comes to
USER:
Summarize this.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 18 | 2 | 241 | null | 434 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
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give me a 5-7 bullet point list of the errors made by the ai in the text. include why the ai using bias can be harmful and what affects bias
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Some artificial intelligence tools for health care may get confused by the ways people of different genders and races talk, according to a new study led by CU Boulder computer scientist Theodora Chaspari. The study hinges on a, perhaps unspoken, reality of human society: Not everyone talks the same. Women, for example, tend to speak at a higher pitch than men, while similar differences can pop up between, say, white and Black speakers. Now, researchers have found that those natural variations could confound algorithms that screen humans for mental health concerns like anxiety or depression. The results add to a growing body of research showing that AI, just like people, can make assumptions based on race or gender. "If AI isn't trained well, or doesn't include enough representative data, it can propagate these human or societal biases," said Chaspari, associate professor in the Department of Computer Science. She and her colleagues published their findings July 24 in the journal Frontiers in Digital Health. Chaspari noted that AI could be a promising technology in the healthcare world. Finely tuned algorithms can sift through recordings of people speaking, searching for subtle changes in the way they talk that could indicate underlying mental health concerns. But those tools have to perform consistently for patients from many demographic groups, the computer scientist said. To find out if AI is up to the task, the researchers fed audio samples of real humans into a common set of machine learning algorithms. The results raised a few red flags: The AI tools, for example, seemed to underdiagnose women who were at risk of depression more than men -- an outcome that, in the real world, could keep people from getting the care they need. "With artificial intelligence, we can identify these fine-grained patterns that humans can't always perceive," said Chaspari, who conducted the work as a faculty member at Texas A&M University. "However, while there is this opportunity, there is also a lot of risk." Speech and emotions She added that the way humans talk can be a powerful window into their underlying emotions and wellbeing -- something that poets and playwrights have long known. Research suggests that people diagnosed with clinical depression often speak more softly and in more of a monotone than others. People with anxiety disorders, meanwhile, tend to talk with a higher pitch and with more "jitter," a measurement of the breathiness in speech. "We know that speech is very much influenced by one's anatomy," Chaspari said. "For depression, there have been some studies showing changes in the way vibrations in the vocal folds happen, or even in how the voice is modulated by the vocal tract." Over the years, scientists have developed AI tools to look for just those kinds of changes. Chaspari and her colleagues decided to put the algorithms under the microscope. To do that, the team drew on recordings of humans talking in a range of scenarios: In one, people had to give a 10 to 15 minute talk to a group of strangers. In another, men and women talked for a longer time in a setting similar to a doctor's visit. In both cases, the speakers separately filled out questionnaires about their mental health. The study included Michael Yang and Abd-Allah El-Attar, undergraduate students at Texas A&M. Fixing biases The results seemed to be all over the place. In the public speaking recordings, for example, the Latino participants reported that they felt a lot more nervous on average than the white or Black speakers. The AI, however, failed to detect that heightened anxiety. In the second experiment, the algorithms also flagged equal numbers of men and women as being at risk of depression. In reality, the female speakers had experienced symptoms of depression at much higher rates. Chaspari noted that the team's results are just a first step. The researchers will need to analyze recordings of a lot more people from a wide range of demographic groups before they can understand why the AI fumbled in certain cases -- and how to fix those biases. But, she said, the study is a sign that AI developers should proceed with caution before bringing AI tools into the medical world: "If we think that an algorithm actually underestimates depression for a specific group, this is something we need to inform clinicians about.
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. give me a 5-7 bullet point list of the errors made by the ai in the text. include why the ai using bias can be harmful and what affects bias Some artificial intelligence tools for health care may get confused by the ways people of different genders and races talk, according to a new study led by CU Boulder computer scientist Theodora Chaspari. The study hinges on a, perhaps unspoken, reality of human society: Not everyone talks the same. Women, for example, tend to speak at a higher pitch than men, while similar differences can pop up between, say, white and Black speakers. Now, researchers have found that those natural variations could confound algorithms that screen humans for mental health concerns like anxiety or depression. The results add to a growing body of research showing that AI, just like people, can make assumptions based on race or gender. "If AI isn't trained well, or doesn't include enough representative data, it can propagate these human or societal biases," said Chaspari, associate professor in the Department of Computer Science. She and her colleagues published their findings July 24 in the journal Frontiers in Digital Health. Chaspari noted that AI could be a promising technology in the healthcare world. Finely tuned algorithms can sift through recordings of people speaking, searching for subtle changes in the way they talk that could indicate underlying mental health concerns. But those tools have to perform consistently for patients from many demographic groups, the computer scientist said. To find out if AI is up to the task, the researchers fed audio samples of real humans into a common set of machine learning algorithms. The results raised a few red flags: The AI tools, for example, seemed to underdiagnose women who were at risk of depression more than men -- an outcome that, in the real world, could keep people from getting the care they need. "With artificial intelligence, we can identify these fine-grained patterns that humans can't always perceive," said Chaspari, who conducted the work as a faculty member at Texas A&M University. "However, while there is this opportunity, there is also a lot of risk." Speech and emotions She added that the way humans talk can be a powerful window into their underlying emotions and wellbeing -- something that poets and playwrights have long known. Research suggests that people diagnosed with clinical depression often speak more softly and in more of a monotone than others. People with anxiety disorders, meanwhile, tend to talk with a higher pitch and with more "jitter," a measurement of the breathiness in speech. "We know that speech is very much influenced by one's anatomy," Chaspari said. "For depression, there have been some studies showing changes in the way vibrations in the vocal folds happen, or even in how the voice is modulated by the vocal tract." Over the years, scientists have developed AI tools to look for just those kinds of changes. Chaspari and her colleagues decided to put the algorithms under the microscope. To do that, the team drew on recordings of humans talking in a range of scenarios: In one, people had to give a 10 to 15 minute talk to a group of strangers. In another, men and women talked for a longer time in a setting similar to a doctor's visit. In both cases, the speakers separately filled out questionnaires about their mental health. The study included Michael Yang and Abd-Allah El-Attar, undergraduate students at Texas A&M. Fixing biases The results seemed to be all over the place. In the public speaking recordings, for example, the Latino participants reported that they felt a lot more nervous on average than the white or Black speakers. The AI, however, failed to detect that heightened anxiety. In the second experiment, the algorithms also flagged equal numbers of men and women as being at risk of depression. In reality, the female speakers had experienced symptoms of depression at much higher rates. Chaspari noted that the team's results are just a first step. The researchers will need to analyze recordings of a lot more people from a wide range of demographic groups before they can understand why the AI fumbled in certain cases -- and how to fix those biases. But, she said, the study is a sign that AI developers should proceed with caution before bringing AI tools into the medical world: "If we think that an algorithm actually underestimates depression for a specific group, this is something we need to inform clinicians about. https://www.sciencedaily.com/releases/2024/08/240805134143.htm
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
Some artificial intelligence tools for health care may get confused by the ways people of different genders and races talk, according to a new study led by CU Boulder computer scientist Theodora Chaspari. The study hinges on a, perhaps unspoken, reality of human society: Not everyone talks the same. Women, for example, tend to speak at a higher pitch than men, while similar differences can pop up between, say, white and Black speakers. Now, researchers have found that those natural variations could confound algorithms that screen humans for mental health concerns like anxiety or depression. The results add to a growing body of research showing that AI, just like people, can make assumptions based on race or gender. "If AI isn't trained well, or doesn't include enough representative data, it can propagate these human or societal biases," said Chaspari, associate professor in the Department of Computer Science. She and her colleagues published their findings July 24 in the journal Frontiers in Digital Health. Chaspari noted that AI could be a promising technology in the healthcare world. Finely tuned algorithms can sift through recordings of people speaking, searching for subtle changes in the way they talk that could indicate underlying mental health concerns. But those tools have to perform consistently for patients from many demographic groups, the computer scientist said. To find out if AI is up to the task, the researchers fed audio samples of real humans into a common set of machine learning algorithms. The results raised a few red flags: The AI tools, for example, seemed to underdiagnose women who were at risk of depression more than men -- an outcome that, in the real world, could keep people from getting the care they need. "With artificial intelligence, we can identify these fine-grained patterns that humans can't always perceive," said Chaspari, who conducted the work as a faculty member at Texas A&M University. "However, while there is this opportunity, there is also a lot of risk." Speech and emotions She added that the way humans talk can be a powerful window into their underlying emotions and wellbeing -- something that poets and playwrights have long known. Research suggests that people diagnosed with clinical depression often speak more softly and in more of a monotone than others. People with anxiety disorders, meanwhile, tend to talk with a higher pitch and with more "jitter," a measurement of the breathiness in speech. "We know that speech is very much influenced by one's anatomy," Chaspari said. "For depression, there have been some studies showing changes in the way vibrations in the vocal folds happen, or even in how the voice is modulated by the vocal tract." Over the years, scientists have developed AI tools to look for just those kinds of changes. Chaspari and her colleagues decided to put the algorithms under the microscope. To do that, the team drew on recordings of humans talking in a range of scenarios: In one, people had to give a 10 to 15 minute talk to a group of strangers. In another, men and women talked for a longer time in a setting similar to a doctor's visit. In both cases, the speakers separately filled out questionnaires about their mental health. The study included Michael Yang and Abd-Allah El-Attar, undergraduate students at Texas A&M. Fixing biases The results seemed to be all over the place. In the public speaking recordings, for example, the Latino participants reported that they felt a lot more nervous on average than the white or Black speakers. The AI, however, failed to detect that heightened anxiety. In the second experiment, the algorithms also flagged equal numbers of men and women as being at risk of depression. In reality, the female speakers had experienced symptoms of depression at much higher rates. Chaspari noted that the team's results are just a first step. The researchers will need to analyze recordings of a lot more people from a wide range of demographic groups before they can understand why the AI fumbled in certain cases -- and how to fix those biases. But, she said, the study is a sign that AI developers should proceed with caution before bringing AI tools into the medical world: "If we think that an algorithm actually underestimates depression for a specific group, this is something we need to inform clinicians about.
USER:
give me a 5-7 bullet point list of the errors made by the ai in the text. include why the ai using bias can be harmful and what affects bias
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 30 | 722 | null | 197 |
You must only provide your answer using the information I give to you. If you're unable to, you should respond by telling me "I can't do that."
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Why is a gait analysis important when buying shoes?
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Footwear is an important item of equipment to prevent injury and provide comfort while walking. The most suitable footwear for this exercise program is within the “running” category. Cross trainers, court, training or walking shoes are not as good a choice for many reasons. To best meet your personal requirements and to address the heel-toe motion of walking or running, choose shoes in the “running” category of footwear only. An experienced professional can provide a general gait (walking stride) analysis to determine your personal footwear needs. The best merchants with the most expertise are specialty running shops, where staff is generally trained to assess feet for everyone from walkers to long distance runners. Features of the Running Shoe The uppers of most running shoes today are seamless (no stitching or rough spots that can cause irritation or blistering) and made of durable lightweight, breathable materials. This is important for fit, breathability and flexibility. The midsole will look (and feel) different, depending on the degree of support systems present. Different feet require different footwear. At one extreme is the low arch, “flat” or highly flexible foot. This foot may require heightened guidance that is often achieved through having two or more different densities of material in the midsole with typically more medial (inside of the foot) density or firmness. This firmness helps to provide the structure and support needed by this foot type. At the opposite end of the spectrum is the rigid, high instep, inflexible foot. This foot has very different needs compared to low arched feet. Flexibility and shock absorption are the focus for this type of foot. Often the midsoles of this subcategory are of a single density and generally softer in feel. Shoes in the running category should come with removable insoles. If they don’t come with removable insoles, they are likely unsuitable. Removable insoles allow for the use of orthotics and also the occasional washing. Insoles are made of light weight foam that will shrink if you wash them in hot water or put them in the dryer. Wash them in cold water by hand and air dry only. If you wear orthotics, be sure to have them with you when purchasing footwear and always remove the manufacture’s insole when using an orthotic. What to Keep in Mind When Purchasing Footwear A general gait analysis is necessary to determine your foot type and ultimately the best shoes to match them. Have your feet and gait (walking stride) observed by a qualified salesperson. This will determine the subcategory best suited for your personal needs. Call ahead of time and ask if there is someone that can “check my gait.” If they do not offer this service, call another place. Be sure the salesperson watches you walk or run in the shoes you are testing. This will determine if a shoe is over-correcting or under-correcting your gait. Without a gait analysis during the fitting process, it’s just guesswork. Do not be fooled by a really soft, cushy feel. A softer midsole has less structure. This means that your feet will have to work harder to stabilize your body while walking. Walking for longer periods of time in an extremely soft shoe will inevitably tire you quickly and heighten your susceptibility to injury. Although some feet do require high shock absorption (high arched, rigid foot types), it’s important to make the distinction between cushion and shock absorbency. How a shoe fits is important. Do not settle for a shoe that is too roomy or too tight fitting. Shoes are readily available in a variety of widths to meet the needs of the widest or narrowest of feet. An ideal fit will be roomy in the toe box. This will allow your toes to spread comfortably when you are in the ‘toe off’ phase of your stride. If a shoe is too snug around your toes, you run the risk of blistering or bruising. Aim for approximately .8 cm or 1/4 inch of space between your longest toe and the end of the shoe. This extra space will also allow for swelling as you exercise, especially on those warmer days. Shoes will last 6 to 12 months or 800 to 1200km. This will vary according to your foot strike and the conditions they are worn in. For people with limited mobility If you have recently experienced a stroke and/or are limited in your mobility, it is important to choose footwear that will not inhibit your rehab. Safety comes first. In this case, walking stride is less important than preventing falls. Where mobility is low and walking aids are used, it’s best to choose footwear that is lightweight, highly flexible and low profile (thin midsole or low to the ground). Tripping hazards will be diminished and your rehab will be less restricted. As you progress in your rehab, become more mobile, walk longer distances or for longer periods of time, you will then want to have a reanalysis of your gait and choose footwear emphasizing those needs as described above.
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You must only provide your answer using the information I give to you. If you're unable to, you should respond by telling me "I can't do that." Footwear is an important item of equipment to prevent injury and provide comfort while walking. The most suitable footwear for this exercise program is within the “running” category. Cross trainers, court, training or walking shoes are not as good a choice for many reasons. To best meet your personal requirements and to address the heel-toe motion of walking or running, choose shoes in the “running” category of footwear only. An experienced professional can provide a general gait (walking stride) analysis to determine your personal footwear needs. The best merchants with the most expertise are specialty running shops, where staff is generally trained to assess feet for everyone from walkers to long distance runners. Features of the Running Shoe The uppers of most running shoes today are seamless (no stitching or rough spots that can cause irritation or blistering) and made of durable lightweight, breathable materials. This is important for fit, breathability and flexibility. The midsole will look (and feel) different, depending on the degree of support systems present. Different feet require different footwear. At one extreme is the low arch, “flat” or highly flexible foot. This foot may require heightened guidance that is often achieved through having two or more different densities of material in the midsole with typically more medial (inside of the foot) density or firmness. This firmness helps to provide the structure and support needed by this foot type. At the opposite end of the spectrum is the rigid, high instep, inflexible foot. This foot has very different needs compared to low arched feet. Flexibility and shock absorption are the focus for this type of foot. Often the midsoles of this subcategory are of a single density and generally softer in feel. Shoes in the running category should come with removable insoles. If they don’t come with removable insoles, they are likely unsuitable. Removable insoles allow for the use of orthotics and also the occasional washing. Insoles are made of light weight foam that will shrink if you wash them in hot water or put them in the dryer. Wash them in cold water by hand and air dry only. If you wear orthotics, be sure to have them with you when purchasing footwear and always remove the manufacture’s insole when using an orthotic. What to Keep in Mind When Purchasing Footwear A general gait analysis is necessary to determine your foot type and ultimately the best shoes to match them. Have your feet and gait (walking stride) observed by a qualified salesperson. This will determine the subcategory best suited for your personal needs. Call ahead of time and ask if there is someone that can “check my gait.” If they do not offer this service, call another place. Be sure the salesperson watches you walk or run in the shoes you are testing. This will determine if a shoe is over-correcting or under-correcting your gait. Without a gait analysis during the fitting process, it’s just guesswork. Do not be fooled by a really soft, cushy feel. A softer midsole has less structure. This means that your feet will have to work harder to stabilize your body while walking. Walking for longer periods of time in an extremely soft shoe will inevitably tire you quickly and heighten your susceptibility to injury. Although some feet do require high shock absorption (high arched, rigid foot types), it’s important to make the distinction between cushion and shock absorbency. How a shoe fits is important. Do not settle for a shoe that is too roomy or too tight fitting. Shoes are readily available in a variety of widths to meet the needs of the widest or narrowest of feet. An ideal fit will be roomy in the toe box. This will allow your toes to spread comfortably when you are in the ‘toe off’ phase of your stride. If a shoe is too snug around your toes, you run the risk of blistering or bruising. Aim for approximately .8 cm or 1/4 inch of space between your longest toe and the end of the shoe. This extra space will also allow for swelling as you exercise, especially on those warmer days. Shoes will last 6 to 12 months or 800 to 1200km. This will vary according to your foot strike and the conditions they are worn in. For people with limited mobility If you have recently experienced a stroke and/or are limited in your mobility, it is important to choose footwear that will not inhibit your rehab. Safety comes first. In this case, walking stride is less important than preventing falls. Where mobility is low and walking aids are used, it’s best to choose footwear that is lightweight, highly flexible and low profile (thin midsole or low to the ground). Tripping hazards will be diminished and your rehab will be less restricted. As you progress in your rehab, become more mobile, walk longer distances or for longer periods of time, you will then want to have a reanalysis of your gait and choose footwear emphasizing those needs as described above. Why is a gait analysis important when buying shoes?
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You must only provide your answer using the information I give to you. If you're unable to, you should respond by telling me "I can't do that."
EVIDENCE:
Footwear is an important item of equipment to prevent injury and provide comfort while walking. The most suitable footwear for this exercise program is within the “running” category. Cross trainers, court, training or walking shoes are not as good a choice for many reasons. To best meet your personal requirements and to address the heel-toe motion of walking or running, choose shoes in the “running” category of footwear only. An experienced professional can provide a general gait (walking stride) analysis to determine your personal footwear needs. The best merchants with the most expertise are specialty running shops, where staff is generally trained to assess feet for everyone from walkers to long distance runners. Features of the Running Shoe The uppers of most running shoes today are seamless (no stitching or rough spots that can cause irritation or blistering) and made of durable lightweight, breathable materials. This is important for fit, breathability and flexibility. The midsole will look (and feel) different, depending on the degree of support systems present. Different feet require different footwear. At one extreme is the low arch, “flat” or highly flexible foot. This foot may require heightened guidance that is often achieved through having two or more different densities of material in the midsole with typically more medial (inside of the foot) density or firmness. This firmness helps to provide the structure and support needed by this foot type. At the opposite end of the spectrum is the rigid, high instep, inflexible foot. This foot has very different needs compared to low arched feet. Flexibility and shock absorption are the focus for this type of foot. Often the midsoles of this subcategory are of a single density and generally softer in feel. Shoes in the running category should come with removable insoles. If they don’t come with removable insoles, they are likely unsuitable. Removable insoles allow for the use of orthotics and also the occasional washing. Insoles are made of light weight foam that will shrink if you wash them in hot water or put them in the dryer. Wash them in cold water by hand and air dry only. If you wear orthotics, be sure to have them with you when purchasing footwear and always remove the manufacture’s insole when using an orthotic. What to Keep in Mind When Purchasing Footwear A general gait analysis is necessary to determine your foot type and ultimately the best shoes to match them. Have your feet and gait (walking stride) observed by a qualified salesperson. This will determine the subcategory best suited for your personal needs. Call ahead of time and ask if there is someone that can “check my gait.” If they do not offer this service, call another place. Be sure the salesperson watches you walk or run in the shoes you are testing. This will determine if a shoe is over-correcting or under-correcting your gait. Without a gait analysis during the fitting process, it’s just guesswork. Do not be fooled by a really soft, cushy feel. A softer midsole has less structure. This means that your feet will have to work harder to stabilize your body while walking. Walking for longer periods of time in an extremely soft shoe will inevitably tire you quickly and heighten your susceptibility to injury. Although some feet do require high shock absorption (high arched, rigid foot types), it’s important to make the distinction between cushion and shock absorbency. How a shoe fits is important. Do not settle for a shoe that is too roomy or too tight fitting. Shoes are readily available in a variety of widths to meet the needs of the widest or narrowest of feet. An ideal fit will be roomy in the toe box. This will allow your toes to spread comfortably when you are in the ‘toe off’ phase of your stride. If a shoe is too snug around your toes, you run the risk of blistering or bruising. Aim for approximately .8 cm or 1/4 inch of space between your longest toe and the end of the shoe. This extra space will also allow for swelling as you exercise, especially on those warmer days. Shoes will last 6 to 12 months or 800 to 1200km. This will vary according to your foot strike and the conditions they are worn in. For people with limited mobility If you have recently experienced a stroke and/or are limited in your mobility, it is important to choose footwear that will not inhibit your rehab. Safety comes first. In this case, walking stride is less important than preventing falls. Where mobility is low and walking aids are used, it’s best to choose footwear that is lightweight, highly flexible and low profile (thin midsole or low to the ground). Tripping hazards will be diminished and your rehab will be less restricted. As you progress in your rehab, become more mobile, walk longer distances or for longer periods of time, you will then want to have a reanalysis of your gait and choose footwear emphasizing those needs as described above.
USER:
Why is a gait analysis important when buying shoes?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 27 | 9 | 841 | null | 730 |
Do not use any prior knowledge or external resources. You must answer questions solely on the basis of the information provided in the prompt.
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What are the main legal arguments for and against the FTC's Non-Compete Rule?
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Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority. A 1983 decision from the U.S. Court of Appeals for the Seventh Circuit agreed with the D.C. Circuit’s reasoning in National Petroleum Refiners, but no other federal appellate court has addressed the FTC’s authority to issue legislative rules under Section 6(g). Whether the FTC possesses such authority remains unsettled; some commentators have argued that National Petroleum Refiners was wrongly decided and that it is unlikely that modern courts would reach the same conclusion. In issuing the Non-Compete Rule, the FTC defended its authority to issue substantive rules under Section 6(g) by pointing to the provision’s plain meaning and the D.C. Circuit’s decision in National Petroleum Refiners. The FTC also argued that Congress implicitly ratified the D.C. Circuit’s decision in both the Magnuson-Moss Act and the Federal Trade Commission Improvements Act of 1980 (the 1980 Amendments). The 1980 Amendments imposed procedural requirements that the FTC must follow in issuing any “rule.” It defined the term “rule” to include rules promulgated under Section 6 or Magnuson-Moss. The statute excluded from that definition “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC argued that this exclusion confirms its authority to issue rules under Section 6 that are not merely “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC’s authority to issue the Non-Compete Rule depends not only on whether Section 6(g) authorizes legislative rulemaking, but also on the scope of Section 5’s prohibition of UMC. The Supreme Court has repeatedly said that Section 5 is broader than the Sherman Act and the Clayton Act (the other core federal antitrust laws). However, the scope of this additional coverage—often called the FTC’s “standalone” Section 5 authority—is unsettled. Under previous leadership, the FTC took a narrow view of its standalone Section 5 authority. In a 2015 policy statement, the FTC indicated that decisions to bring standalone Section 5 actions would be guided by considerations of consumer welfare, that the FTC would evaluate challenged conduct under “a framework similar to the rule of reason,” and that the FTC was less likely to bring a standalone Section 5 action if enforcement of the Sherman Act or Clayton Act was sufficient to address the relevant competitive harm. The FTC rescinded this policy statement in 2021 and issued a new Section 5 policy statement the following year. In the 2022 policy statement, the FTC identified “two key criteria” it will consider in evaluating whether a “method of competition” is “unfair.” First, the FTC indicated that “unfair” conduct Congressional Research Service 4 “may be coercive, exploitative, collusive, abusive, deceptive, predatory, or involve the use of economic power of a similar nature,” and “may also be otherwise restrictive or exclusionary.” Second, the FTC explained that such conduct “must tend to negatively affect competitive conditions”—for example, by foreclosing or impairing the opportunities of market participants, reducing competition between rivals, limiting choice, or otherwise harming consumers. The 2022 policy statement indicated that this second inquiry will not turn on whether conduct directly causes harm in particular cases, but instead will focus on whether conduct “has a tendency to generate negative consequences.” In promulgating the Non-Compete Rule, the FTC found that non-competes violate Section 5 because they represent “restrictive and exclusionary conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. The FTC also determined that non-competes for workers other than senior executives violate Section 5 because they constitute “exploitative and coercive conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. (A previous Legal Sidebar provides a more extensive discussion of the FTC’s justification for the Non-Compete Rule.) Two FTC Commissioners voted against the Non-Compete Rule, arguing that the FTC lacks the authority to issue substantive competition regulations and that the evidence did not justify a categorical prohibition of non-competes.
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Do not use any prior knowledge or external resources. You must answer questions solely on the basis of the information provided in the prompt. What are the main legal arguments for and against the FTC's Non-Compete Rule? Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority. A 1983 decision from the U.S. Court of Appeals for the Seventh Circuit agreed with the D.C. Circuit’s reasoning in National Petroleum Refiners, but no other federal appellate court has addressed the FTC’s authority to issue legislative rules under Section 6(g). Whether the FTC possesses such authority remains unsettled; some commentators have argued that National Petroleum Refiners was wrongly decided and that it is unlikely that modern courts would reach the same conclusion. In issuing the Non-Compete Rule, the FTC defended its authority to issue substantive rules under Section 6(g) by pointing to the provision’s plain meaning and the D.C. Circuit’s decision in National Petroleum Refiners. The FTC also argued that Congress implicitly ratified the D.C. Circuit’s decision in both the Magnuson-Moss Act and the Federal Trade Commission Improvements Act of 1980 (the 1980 Amendments). The 1980 Amendments imposed procedural requirements that the FTC must follow in issuing any “rule.” It defined the term “rule” to include rules promulgated under Section 6 or Magnuson-Moss. The statute excluded from that definition “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC argued that this exclusion confirms its authority to issue rules under Section 6 that are not merely “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC’s authority to issue the Non-Compete Rule depends not only on whether Section 6(g) authorizes legislative rulemaking, but also on the scope of Section 5’s prohibition of UMC. The Supreme Court has repeatedly said that Section 5 is broader than the Sherman Act and the Clayton Act (the other core federal antitrust laws). However, the scope of this additional coverage—often called the FTC’s “standalone” Section 5 authority—is unsettled. Under previous leadership, the FTC took a narrow view of its standalone Section 5 authority. In a 2015 policy statement, the FTC indicated that decisions to bring standalone Section 5 actions would be guided by considerations of consumer welfare, that the FTC would evaluate challenged conduct under “a framework similar to the rule of reason,” and that the FTC was less likely to bring a standalone Section 5 action if enforcement of the Sherman Act or Clayton Act was sufficient to address the relevant competitive harm. The FTC rescinded this policy statement in 2021 and issued a new Section 5 policy statement the following year. In the 2022 policy statement, the FTC identified “two key criteria” it will consider in evaluating whether a “method of competition” is “unfair.” First, the FTC indicated that “unfair” conduct Congressional Research Service 4 “may be coercive, exploitative, collusive, abusive, deceptive, predatory, or involve the use of economic power of a similar nature,” and “may also be otherwise restrictive or exclusionary.” Second, the FTC explained that such conduct “must tend to negatively affect competitive conditions”—for example, by foreclosing or impairing the opportunities of market participants, reducing competition between rivals, limiting choice, or otherwise harming consumers. The 2022 policy statement indicated that this second inquiry will not turn on whether conduct directly causes harm in particular cases, but instead will focus on whether conduct “has a tendency to generate negative consequences.” In promulgating the Non-Compete Rule, the FTC found that non-competes violate Section 5 because they represent “restrictive and exclusionary conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. The FTC also determined that non-competes for workers other than senior executives violate Section 5 because they constitute “exploitative and coercive conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. (A previous Legal Sidebar provides a more extensive discussion of the FTC’s justification for the Non-Compete Rule.) Two FTC Commissioners voted against the Non-Compete Rule, arguing that the FTC lacks the authority to issue substantive competition regulations and that the evidence did not justify a categorical prohibition of non-competes.
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Do not use any prior knowledge or external resources. You must answer questions solely on the basis of the information provided in the prompt.
EVIDENCE:
Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority. A 1983 decision from the U.S. Court of Appeals for the Seventh Circuit agreed with the D.C. Circuit’s reasoning in National Petroleum Refiners, but no other federal appellate court has addressed the FTC’s authority to issue legislative rules under Section 6(g). Whether the FTC possesses such authority remains unsettled; some commentators have argued that National Petroleum Refiners was wrongly decided and that it is unlikely that modern courts would reach the same conclusion. In issuing the Non-Compete Rule, the FTC defended its authority to issue substantive rules under Section 6(g) by pointing to the provision’s plain meaning and the D.C. Circuit’s decision in National Petroleum Refiners. The FTC also argued that Congress implicitly ratified the D.C. Circuit’s decision in both the Magnuson-Moss Act and the Federal Trade Commission Improvements Act of 1980 (the 1980 Amendments). The 1980 Amendments imposed procedural requirements that the FTC must follow in issuing any “rule.” It defined the term “rule” to include rules promulgated under Section 6 or Magnuson-Moss. The statute excluded from that definition “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC argued that this exclusion confirms its authority to issue rules under Section 6 that are not merely “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC’s authority to issue the Non-Compete Rule depends not only on whether Section 6(g) authorizes legislative rulemaking, but also on the scope of Section 5’s prohibition of UMC. The Supreme Court has repeatedly said that Section 5 is broader than the Sherman Act and the Clayton Act (the other core federal antitrust laws). However, the scope of this additional coverage—often called the FTC’s “standalone” Section 5 authority—is unsettled. Under previous leadership, the FTC took a narrow view of its standalone Section 5 authority. In a 2015 policy statement, the FTC indicated that decisions to bring standalone Section 5 actions would be guided by considerations of consumer welfare, that the FTC would evaluate challenged conduct under “a framework similar to the rule of reason,” and that the FTC was less likely to bring a standalone Section 5 action if enforcement of the Sherman Act or Clayton Act was sufficient to address the relevant competitive harm. The FTC rescinded this policy statement in 2021 and issued a new Section 5 policy statement the following year. In the 2022 policy statement, the FTC identified “two key criteria” it will consider in evaluating whether a “method of competition” is “unfair.” First, the FTC indicated that “unfair” conduct Congressional Research Service 4 “may be coercive, exploitative, collusive, abusive, deceptive, predatory, or involve the use of economic power of a similar nature,” and “may also be otherwise restrictive or exclusionary.” Second, the FTC explained that such conduct “must tend to negatively affect competitive conditions”—for example, by foreclosing or impairing the opportunities of market participants, reducing competition between rivals, limiting choice, or otherwise harming consumers. The 2022 policy statement indicated that this second inquiry will not turn on whether conduct directly causes harm in particular cases, but instead will focus on whether conduct “has a tendency to generate negative consequences.” In promulgating the Non-Compete Rule, the FTC found that non-competes violate Section 5 because they represent “restrictive and exclusionary conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. The FTC also determined that non-competes for workers other than senior executives violate Section 5 because they constitute “exploitative and coercive conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. (A previous Legal Sidebar provides a more extensive discussion of the FTC’s justification for the Non-Compete Rule.) Two FTC Commissioners voted against the Non-Compete Rule, arguing that the FTC lacks the authority to issue substantive competition regulations and that the evidence did not justify a categorical prohibition of non-competes.
USER:
What are the main legal arguments for and against the FTC's Non-Compete Rule?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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I'm making a presentation to first-year biology students based on this article. Please summarize this excerpt. Be sure to use language that an 11th grader can understand (but define jargon so that students learn some relevant terminology).
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1 Introduction Cervical squamous intraepithelial lesion (SIL) is a condition characterized by abnormal changes in cervical squamous cells. Although most low-grade squamous intraepithelial lesions (LSILs) can regress naturally within 1–2 years, while high-grade squamous intraepithelial lesions (HSILs) have a higher potential for malignant transformation. Current treatment methods for SIL comprise ablative treatments (such as cryotherapy, radiofrequency, and focused ultrasound treatments) and excision procedures (including cold knife conization, cervical loop electrosurgical excision procedure, and laser conization). In the past few years, there has been an increase in the occurrence of SIL among younger woman. As a result, clinicians and patients are not only concerned about lesion clearance, but also paying attention to cervical wound healing, which has emerged as a new area of interest. SARS-CoV-2, a novel coronavirus, emerged in 2019 and caused a global pandemic of acute respiratory illness named SARS-CoV-2. With the deepening of research, it has been found that SARS-CoV-2 not only affects the respiratory system, but also the digestive system, nervous system, cardiovascular system, endocrine system, reproductive system, and can cause a decrease in the body’s immunity, leading to secondary bacterial infections. However, little is known about the impact of SARS-CoV-2 infection on cervical wound healing after treatment. In this study, we investigated the wound healing status of patients who were infected with SARS-CoV-2 within one month after cervical treatment and compared them with a control group of patients who underwent cervical treatment after the disappearance of infection symptoms. 2 Materials and methods 2.1 Study population A total of 60 patients, aged 19 to 53 years old, who underwent cervical treatment for SILs at the gynecology cervical clinic of the People’s Hospital of Guangxi Zhuang Autonomous Region from November 2022 to February 2023 were recruited as the study population. Informed consent was obtained from all subjects involved in the study. The inclusion criteria for patients were a diagnosis of SIL using the three-step method of cervical cytology, which including HPV test, colposcopy, and cervical biopsy. The exclusion criteria included: patients with acute or subacute genital infections, genital malignancy, a history of hysterectomy or pelvic radiotherapy, a history of cervical excision, cervical ablation, or medication treatment, pregnant or lactating women, uncontrolled diabetes, hyperthyroidism or hypothyroidism, severe cardiovascular, cerebral, pulmonary, hepatic, or renal dysfunction, or comorbidities of immunological disorders or immunosuppressive drug use. The experimental group consisted of 29 patients who exhibited symptoms (such as fever, sore throat, and cough) and were confirmed to have SARS-CoV-2 infection through antigen testing within one month of receiving cervical treatment. The control group comprised t31 patients who underwent cervical treatment at least one week after their SARS-CoV-2 symptoms had resolved. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Guangxi Zhuang Autonomous Region People’s Hospital (no. KY-KJT02023-10) on August 01, 2022. 2.2 Treatment methods All cervical treatments were performed 3–7 days after the end of menstruation, excluding patients who have reached menopause. To assess the extent of the cervical lesion, acetic acid and iodine are applied to stain the junction of the cervical squamous epithelium and columnar epithelium. Local anesthesia with 1% lidocaine is administered at the 4 quadrants of the cervix. The cervical SILs are treated using either loop electrosurgical excision procedure (LEEP) or ablative treatment such as focused ultrasound or radiofrequency ablation. Details regarding the indications for patients undergoing LEEP excision or ablative treatment can be found in the Supplementary materials. The (LEEP) is performed using a triangular-shaped electrosurgical knife with a length of 15–20 mm, The treatment area is set to approximately 5 mm from the outer edge of the lesion, utilizing a cutting-coagulation mode with a power setting of 40 W. Depending on the type of transformation zone, different lengths of lesion tissue are removed (7–10 mm for type 1, 10–15 mm for type 2, and 15–25 mm for type 3). Following excision, a ball-shaped electrode is used to perform electrocoagulation for hemostasis at the surgical site. The power setting for focused ultrasound therapy is between 3.5 and 4.5 W. Treatment is performed in a circular scanning pattern from the lesion area toward the normal area. During the treatment, the focused ultrasound probe is kept in close contact with the treatment area. The treatment should be stopped when local tissues become concave or hardened. The treatment range should extend beyond the edge of the cervical lesion by approximately 2–5 mm. The power for radiofrequency ablation is set to 30 W. The treatment area extends beyond the area that tests positive in acetic acid and iodine tests by 2–5 mm. An auto-coagulator knife is used to ablate the cervical epithelium from the inside out, until the epithelium is thermocoagulated to a light yellow color and the wound has formed a shallow cone shape. 2.3 Cervical wound healing evaluation after treatment Assessing the rate of wound healing is a key factor in evaluating the progress of wound recovery. A comprehensive evaluation of the healing process includes recording the cervical wound condition immediately after treatment and at a specified time-point after treatment. The wound area is measured using Imagine J software (National Institutes of Health, Bethesda, MD). To calculate the wound healing rate, the formula [(treatment wound area - remaining wound area)/treatment wound area] × 100% is applied. This approach enables clinicians to quantitatively assess the healing process and monitor the progress of wound closure over time. Specifically, the calculation is performed on the 30th day after treatment, providing a comprehensive evaluation of healing rate. 2.4 Vaginal discharge test before and one month after treatment Before undergoing cervical treatment, each patient underwent a vaginal discharge examination to rule out vaginal inflammation. During the one-month follow-up vaginal colposcopy after receiving cervical treatment, another examination of vaginal discharge was conducted to assess the vaginal microbiota and inflammatory condition. 4 Results There were no significant differences between the two groups in terms of age, disease severity, treatment methods, or treatment duration. The mean time of SARS-CoV-2 infection in post-treatment infection group is 15.83 ± 9.74 days after cervical treatment, and the mean time of SARS-CoV-2 infection in treatment after infection recovered group is 39.13 ± 9.80 days before cervical treatment. Compared with the control group, the experimental group had a lower wound healing rate 83.77 (62.04, 97.09) % vs. 98.64(97.10, 99.46)%, p < 0.001. The Box and whisker plot of the wound healing rate for the two group was shown in Supplementary Figure 1. Also the experimental group had a higher scab non-shedding rate 24.14% (7/29) on the 30th day after treatment when compared with control group (24.14% vs. 3.22%, p = 0.024). We conducted further analysis to explore the potential correlation between delayed wound healing and the timing of SARS-CoV-2 infection in the experimental group. Out of the 7 patients who experienced delayed wound healing, 5 patients (71.43%) contracted SARS-CoV-2 within 2 weeks after undergoing cervical treatment, only 2 (2/7 or 28.57%) patients infected with delayed wound healing infected SARS-CoV-2 2 weeks after cervical treatment. It is worth noting that in the control group, there was only 1 patient who experienced poor wound healing, and the cervical treatment of this patient was conducted 45 days after SARS-CoV-2 infection. Pre-treatment vaginal discharge tests for all patients exhibited normal levels of white blood cell counts and leukocyte esterase, with no detection of trichomonas vaginalis, pseudohyphae, or budding spores in both pre and post-treatment assessments. We compared the correlation between white blood cell count and leukocyte esterase in vaginal discharge with cervical healing. The results of the chi-square test for contingency table revealed no significant correlation between white blood cell count or leukocyte esterase in vaginal discharge and delayed wound healing of the cervix (defined as the non-shedding of scabs after 1 month of treatment) (p = 0.947 and 0.970, respectively).
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[question] I'm making a presentation to first-year biology students based on this article. Please summarize this excerpt. Be sure to use language that an 11th grader can understand (but define jargon so that students learn some relevant terminology). ===================== [text] 1 Introduction Cervical squamous intraepithelial lesion (SIL) is a condition characterized by abnormal changes in cervical squamous cells. Although most low-grade squamous intraepithelial lesions (LSILs) can regress naturally within 1–2 years, while high-grade squamous intraepithelial lesions (HSILs) have a higher potential for malignant transformation. Current treatment methods for SIL comprise ablative treatments (such as cryotherapy, radiofrequency, and focused ultrasound treatments) and excision procedures (including cold knife conization, cervical loop electrosurgical excision procedure, and laser conization). In the past few years, there has been an increase in the occurrence of SIL among younger woman. As a result, clinicians and patients are not only concerned about lesion clearance, but also paying attention to cervical wound healing, which has emerged as a new area of interest. SARS-CoV-2, a novel coronavirus, emerged in 2019 and caused a global pandemic of acute respiratory illness named SARS-CoV-2. With the deepening of research, it has been found that SARS-CoV-2 not only affects the respiratory system, but also the digestive system, nervous system, cardiovascular system, endocrine system, reproductive system, and can cause a decrease in the body’s immunity, leading to secondary bacterial infections. However, little is known about the impact of SARS-CoV-2 infection on cervical wound healing after treatment. In this study, we investigated the wound healing status of patients who were infected with SARS-CoV-2 within one month after cervical treatment and compared them with a control group of patients who underwent cervical treatment after the disappearance of infection symptoms. 2 Materials and methods 2.1 Study population A total of 60 patients, aged 19 to 53 years old, who underwent cervical treatment for SILs at the gynecology cervical clinic of the People’s Hospital of Guangxi Zhuang Autonomous Region from November 2022 to February 2023 were recruited as the study population. Informed consent was obtained from all subjects involved in the study. The inclusion criteria for patients were a diagnosis of SIL using the three-step method of cervical cytology, which including HPV test, colposcopy, and cervical biopsy. The exclusion criteria included: patients with acute or subacute genital infections, genital malignancy, a history of hysterectomy or pelvic radiotherapy, a history of cervical excision, cervical ablation, or medication treatment, pregnant or lactating women, uncontrolled diabetes, hyperthyroidism or hypothyroidism, severe cardiovascular, cerebral, pulmonary, hepatic, or renal dysfunction, or comorbidities of immunological disorders or immunosuppressive drug use. The experimental group consisted of 29 patients who exhibited symptoms (such as fever, sore throat, and cough) and were confirmed to have SARS-CoV-2 infection through antigen testing within one month of receiving cervical treatment. The control group comprised t31 patients who underwent cervical treatment at least one week after their SARS-CoV-2 symptoms had resolved. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Guangxi Zhuang Autonomous Region People’s Hospital (no. KY-KJT02023-10) on August 01, 2022. 2.2 Treatment methods All cervical treatments were performed 3–7 days after the end of menstruation, excluding patients who have reached menopause. To assess the extent of the cervical lesion, acetic acid and iodine are applied to stain the junction of the cervical squamous epithelium and columnar epithelium. Local anesthesia with 1% lidocaine is administered at the 4 quadrants of the cervix. The cervical SILs are treated using either loop electrosurgical excision procedure (LEEP) or ablative treatment such as focused ultrasound or radiofrequency ablation. Details regarding the indications for patients undergoing LEEP excision or ablative treatment can be found in the Supplementary materials. The (LEEP) is performed using a triangular-shaped electrosurgical knife with a length of 15–20 mm, The treatment area is set to approximately 5 mm from the outer edge of the lesion, utilizing a cutting-coagulation mode with a power setting of 40 W. Depending on the type of transformation zone, different lengths of lesion tissue are removed (7–10 mm for type 1, 10–15 mm for type 2, and 15–25 mm for type 3). Following excision, a ball-shaped electrode is used to perform electrocoagulation for hemostasis at the surgical site. The power setting for focused ultrasound therapy is between 3.5 and 4.5 W. Treatment is performed in a circular scanning pattern from the lesion area toward the normal area. During the treatment, the focused ultrasound probe is kept in close contact with the treatment area. The treatment should be stopped when local tissues become concave or hardened. The treatment range should extend beyond the edge of the cervical lesion by approximately 2–5 mm. The power for radiofrequency ablation is set to 30 W. The treatment area extends beyond the area that tests positive in acetic acid and iodine tests by 2–5 mm. An auto-coagulator knife is used to ablate the cervical epithelium from the inside out, until the epithelium is thermocoagulated to a light yellow color and the wound has formed a shallow cone shape. 2.3 Cervical wound healing evaluation after treatment Assessing the rate of wound healing is a key factor in evaluating the progress of wound recovery. A comprehensive evaluation of the healing process includes recording the cervical wound condition immediately after treatment and at a specified time-point after treatment. The wound area is measured using Imagine J software (National Institutes of Health, Bethesda, MD). To calculate the wound healing rate, the formula [(treatment wound area - remaining wound area)/treatment wound area] × 100% is applied. This approach enables clinicians to quantitatively assess the healing process and monitor the progress of wound closure over time. Specifically, the calculation is performed on the 30th day after treatment, providing a comprehensive evaluation of healing rate. 2.4 Vaginal discharge test before and one month after treatment Before undergoing cervical treatment, each patient underwent a vaginal discharge examination to rule out vaginal inflammation. During the one-month follow-up vaginal colposcopy after receiving cervical treatment, another examination of vaginal discharge was conducted to assess the vaginal microbiota and inflammatory condition. 4 Results There were no significant differences between the two groups in terms of age, disease severity, treatment methods, or treatment duration. The mean time of SARS-CoV-2 infection in post-treatment infection group is 15.83 ± 9.74 days after cervical treatment, and the mean time of SARS-CoV-2 infection in treatment after infection recovered group is 39.13 ± 9.80 days before cervical treatment. Compared with the control group, the experimental group had a lower wound healing rate 83.77 (62.04, 97.09) % vs. 98.64(97.10, 99.46)%, p < 0.001. The Box and whisker plot of the wound healing rate for the two group was shown in Supplementary Figure 1. Also the experimental group had a higher scab non-shedding rate 24.14% (7/29) on the 30th day after treatment when compared with control group (24.14% vs. 3.22%, p = 0.024). We conducted further analysis to explore the potential correlation between delayed wound healing and the timing of SARS-CoV-2 infection in the experimental group. Out of the 7 patients who experienced delayed wound healing, 5 patients (71.43%) contracted SARS-CoV-2 within 2 weeks after undergoing cervical treatment, only 2 (2/7 or 28.57%) patients infected with delayed wound healing infected SARS-CoV-2 2 weeks after cervical treatment. It is worth noting that in the control group, there was only 1 patient who experienced poor wound healing, and the cervical treatment of this patient was conducted 45 days after SARS-CoV-2 infection. Pre-treatment vaginal discharge tests for all patients exhibited normal levels of white blood cell counts and leukocyte esterase, with no detection of trichomonas vaginalis, pseudohyphae, or budding spores in both pre and post-treatment assessments. We compared the correlation between white blood cell count and leukocyte esterase in vaginal discharge with cervical healing. The results of the chi-square test for contingency table revealed no significant correlation between white blood cell count or leukocyte esterase in vaginal discharge and delayed wound healing of the cervix (defined as the non-shedding of scabs after 1 month of treatment) (p = 0.947 and 0.970, respectively). https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1222767/full ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
1 Introduction Cervical squamous intraepithelial lesion (SIL) is a condition characterized by abnormal changes in cervical squamous cells. Although most low-grade squamous intraepithelial lesions (LSILs) can regress naturally within 1–2 years, while high-grade squamous intraepithelial lesions (HSILs) have a higher potential for malignant transformation. Current treatment methods for SIL comprise ablative treatments (such as cryotherapy, radiofrequency, and focused ultrasound treatments) and excision procedures (including cold knife conization, cervical loop electrosurgical excision procedure, and laser conization). In the past few years, there has been an increase in the occurrence of SIL among younger woman. As a result, clinicians and patients are not only concerned about lesion clearance, but also paying attention to cervical wound healing, which has emerged as a new area of interest. SARS-CoV-2, a novel coronavirus, emerged in 2019 and caused a global pandemic of acute respiratory illness named SARS-CoV-2. With the deepening of research, it has been found that SARS-CoV-2 not only affects the respiratory system, but also the digestive system, nervous system, cardiovascular system, endocrine system, reproductive system, and can cause a decrease in the body’s immunity, leading to secondary bacterial infections. However, little is known about the impact of SARS-CoV-2 infection on cervical wound healing after treatment. In this study, we investigated the wound healing status of patients who were infected with SARS-CoV-2 within one month after cervical treatment and compared them with a control group of patients who underwent cervical treatment after the disappearance of infection symptoms. 2 Materials and methods 2.1 Study population A total of 60 patients, aged 19 to 53 years old, who underwent cervical treatment for SILs at the gynecology cervical clinic of the People’s Hospital of Guangxi Zhuang Autonomous Region from November 2022 to February 2023 were recruited as the study population. Informed consent was obtained from all subjects involved in the study. The inclusion criteria for patients were a diagnosis of SIL using the three-step method of cervical cytology, which including HPV test, colposcopy, and cervical biopsy. The exclusion criteria included: patients with acute or subacute genital infections, genital malignancy, a history of hysterectomy or pelvic radiotherapy, a history of cervical excision, cervical ablation, or medication treatment, pregnant or lactating women, uncontrolled diabetes, hyperthyroidism or hypothyroidism, severe cardiovascular, cerebral, pulmonary, hepatic, or renal dysfunction, or comorbidities of immunological disorders or immunosuppressive drug use. The experimental group consisted of 29 patients who exhibited symptoms (such as fever, sore throat, and cough) and were confirmed to have SARS-CoV-2 infection through antigen testing within one month of receiving cervical treatment. The control group comprised t31 patients who underwent cervical treatment at least one week after their SARS-CoV-2 symptoms had resolved. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Guangxi Zhuang Autonomous Region People’s Hospital (no. KY-KJT02023-10) on August 01, 2022. 2.2 Treatment methods All cervical treatments were performed 3–7 days after the end of menstruation, excluding patients who have reached menopause. To assess the extent of the cervical lesion, acetic acid and iodine are applied to stain the junction of the cervical squamous epithelium and columnar epithelium. Local anesthesia with 1% lidocaine is administered at the 4 quadrants of the cervix. The cervical SILs are treated using either loop electrosurgical excision procedure (LEEP) or ablative treatment such as focused ultrasound or radiofrequency ablation. Details regarding the indications for patients undergoing LEEP excision or ablative treatment can be found in the Supplementary materials. The (LEEP) is performed using a triangular-shaped electrosurgical knife with a length of 15–20 mm, The treatment area is set to approximately 5 mm from the outer edge of the lesion, utilizing a cutting-coagulation mode with a power setting of 40 W. Depending on the type of transformation zone, different lengths of lesion tissue are removed (7–10 mm for type 1, 10–15 mm for type 2, and 15–25 mm for type 3). Following excision, a ball-shaped electrode is used to perform electrocoagulation for hemostasis at the surgical site. The power setting for focused ultrasound therapy is between 3.5 and 4.5 W. Treatment is performed in a circular scanning pattern from the lesion area toward the normal area. During the treatment, the focused ultrasound probe is kept in close contact with the treatment area. The treatment should be stopped when local tissues become concave or hardened. The treatment range should extend beyond the edge of the cervical lesion by approximately 2–5 mm. The power for radiofrequency ablation is set to 30 W. The treatment area extends beyond the area that tests positive in acetic acid and iodine tests by 2–5 mm. An auto-coagulator knife is used to ablate the cervical epithelium from the inside out, until the epithelium is thermocoagulated to a light yellow color and the wound has formed a shallow cone shape. 2.3 Cervical wound healing evaluation after treatment Assessing the rate of wound healing is a key factor in evaluating the progress of wound recovery. A comprehensive evaluation of the healing process includes recording the cervical wound condition immediately after treatment and at a specified time-point after treatment. The wound area is measured using Imagine J software (National Institutes of Health, Bethesda, MD). To calculate the wound healing rate, the formula [(treatment wound area - remaining wound area)/treatment wound area] × 100% is applied. This approach enables clinicians to quantitatively assess the healing process and monitor the progress of wound closure over time. Specifically, the calculation is performed on the 30th day after treatment, providing a comprehensive evaluation of healing rate. 2.4 Vaginal discharge test before and one month after treatment Before undergoing cervical treatment, each patient underwent a vaginal discharge examination to rule out vaginal inflammation. During the one-month follow-up vaginal colposcopy after receiving cervical treatment, another examination of vaginal discharge was conducted to assess the vaginal microbiota and inflammatory condition. 4 Results There were no significant differences between the two groups in terms of age, disease severity, treatment methods, or treatment duration. The mean time of SARS-CoV-2 infection in post-treatment infection group is 15.83 ± 9.74 days after cervical treatment, and the mean time of SARS-CoV-2 infection in treatment after infection recovered group is 39.13 ± 9.80 days before cervical treatment. Compared with the control group, the experimental group had a lower wound healing rate 83.77 (62.04, 97.09) % vs. 98.64(97.10, 99.46)%, p < 0.001. The Box and whisker plot of the wound healing rate for the two group was shown in Supplementary Figure 1. Also the experimental group had a higher scab non-shedding rate 24.14% (7/29) on the 30th day after treatment when compared with control group (24.14% vs. 3.22%, p = 0.024). We conducted further analysis to explore the potential correlation between delayed wound healing and the timing of SARS-CoV-2 infection in the experimental group. Out of the 7 patients who experienced delayed wound healing, 5 patients (71.43%) contracted SARS-CoV-2 within 2 weeks after undergoing cervical treatment, only 2 (2/7 or 28.57%) patients infected with delayed wound healing infected SARS-CoV-2 2 weeks after cervical treatment. It is worth noting that in the control group, there was only 1 patient who experienced poor wound healing, and the cervical treatment of this patient was conducted 45 days after SARS-CoV-2 infection. Pre-treatment vaginal discharge tests for all patients exhibited normal levels of white blood cell counts and leukocyte esterase, with no detection of trichomonas vaginalis, pseudohyphae, or budding spores in both pre and post-treatment assessments. We compared the correlation between white blood cell count and leukocyte esterase in vaginal discharge with cervical healing. The results of the chi-square test for contingency table revealed no significant correlation between white blood cell count or leukocyte esterase in vaginal discharge and delayed wound healing of the cervix (defined as the non-shedding of scabs after 1 month of treatment) (p = 0.947 and 0.970, respectively).
USER:
I'm making a presentation to first-year biology students based on this article. Please summarize this excerpt. Be sure to use language that an 11th grader can understand (but define jargon so that students learn some relevant terminology).
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 37 | 1,295 | null | 652 |
Rely solely on the context provided to you to answer any questions. Never use any external resources or prior knowledge to answer questions. Limit your responses to five paragraphs or less.
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Discuss the concept of student loan repayment and forgiveness programs and their relationship to employment choices.
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In assessing the influence of a loan forgiveness or loan repayment program on an individual’s employment choice, one issue to consider is whether, in the absence of such a program, the recipient would have engaged in the qualifying service. Information on the influence of such programs might be gleaned from an examination that compares the career paths of individuals who have access to loan forgiveness or loan repayment benefits with the career paths of otherwise similarly situated individuals without such access. These types of evaluations generally have not been conducted for federal loan forgiveness and loan repayment programs. However, some data from one federal program may be instructive. The National Institutes of Health (NIH) examined the career trajectories of loan repayment recipients in its Intramural Research Program (IRP) and compared them with similar individuals who did not receive loan repayment under the IRP. The purposes of the IRP’s loan repayment component is to encourage individuals to complete medical research at the NIH and to encourage qualified health professionals to continue careers in medical research in general (e.g., at a university). The NIH found that individuals receiving loan repayment benefits were more likely to continue conducting medical research at the NIH than those who did not. Likewise, individuals who received loan repayment benefits but then left the NIH were more likely to continue a career as a medical researcher than those who did not.56 This study suggests that the program may be meeting its stated goals. While the NIH study indicates that its loan repayment program may be meeting its stated goals, the loan repayment program is unlikely the sole reason for at least some of the individuals to remain in the NIH’s targeted positions. Other research has found that some individuals would have entered certain fields or taken certain positions in the absence of loan repayments for a variety of other reasons. If this were true, then the program would not have been necessary and, therefore, might be considered ineffective. For example, a loan repayment program may be an effective incentive when jobs are plentiful for recent graduates who are weighing multiple employment opportunities but may be unnecessary when there are fewer employment opportunities. In relatively recent years, for instance, law school graduates have had fewer employment opportunities57 and may take a public interest or government job because of more limited private sector opportunities. Finally, individuals who accept loan repayment for a specific job might have taken the same job without loan repayment benefits. For example, one study found that healthcare providers who practice in rural areas would have done so without receiving a loan repayment award.58 Although in some cases loan forgiveness or loan repayment programs may appear to be unnecessary, in some instances there is evidence showing that participants would likely not have taken a particular position but for loan repayment. For example, the NIH examined its IRP loan repayment program and found that most loan repayment award recipients had competing job offers and stated that the potential for loan repayment was an attractive benefit that was unique to the NIH employment. This was particularly true for physicians who often had competing job offers at higher salaries. Physicians who received loan repayment benefits were also more likely to remain in research at the NIH, which demonstrates that loan repayment may be an important recruitment and retention tool.59 Other federal agencies have found that loan repayment programs are effective at recruiting and maintaining staff, but there are indications that some aspects of a program’s design may undermine its effectiveness.60 For example, discretionary programs may have their funding reduced or cut altogether, thus making the availability of loan repayment benefits to individuals uncertain. The effectiveness of these programs as a recruitment incentive may be hard to determine because job applicants do not know whether they will receive a loan repayment award until after having accepted a job.61 Additionally, loan repayment award amounts may not be a sufficient incentive for individuals to enter into and remain in certain professions. Some researchers have theorized that loan repayment programs may be more likely to be successful in meeting recruitment and retention needs if the financial benefits are sufficiently meaningful to offset a reasonable share of the costs associated with borrowing to pursue a postsecondary education.62 Similarly, in some circumstances, while the dollar amount of loan repayment benefits may be perceived as sufficient, additional program design elements such as an individual’s responsibility to pay federal income taxes associated with receiving a loan payment may make the benefit less attractive for an individual. Specifically, under the Government Employee Student Loan Repayment Program (GESLRP), participants are responsible for the tax liability, which some agencies estimate can account for 39% of the loan repayment amount.63 Some agencies suggest that this makes the program less attractive to participants than it would be if benefits were excluded from taxation.64 Another consideration is the short-term nature of many of these programs (e.g., providing loan repayment benefits in exchange for a two-year employment commitment), which may contribute to turnover, as individuals may decide to change jobs once they have realized the full benefit of a program. This could possibly lead to a less stable workforce for employers. For example, some researchers have found that individuals who have a service obligation have shorter tenures in a particular position than do individuals who do not have service obligations.65
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In assessing the influence of a loan forgiveness or loan repayment program on an individual’s employment choice, one issue to consider is whether, in the absence of such a program, the recipient would have engaged in the qualifying service. Information on the influence of such programs might be gleaned from an examination that compares the career paths of individuals who have access to loan forgiveness or loan repayment benefits with the career paths of otherwise similarly situated individuals without such access. These types of evaluations generally have not been conducted for federal loan forgiveness and loan repayment programs. However, some data from one federal program may be instructive. The National Institutes of Health (NIH) examined the career trajectories of loan repayment recipients in its Intramural Research Program (IRP) and compared them with similar individuals who did not receive loan repayment under the IRP. The purposes of the IRP’s loan repayment component is to encourage individuals to complete medical research at the NIH and to encourage qualified health professionals to continue careers in medical research in general (e.g., at a university). The NIH found that individuals receiving loan repayment benefits were more likely to continue conducting medical research at the NIH than those who did not. Likewise, individuals who received loan repayment benefits but then left the NIH were more likely to continue a career as a medical researcher than those who did not.56 This study suggests that the program may be meeting its stated goals. While the NIH study indicates that its loan repayment program may be meeting its stated goals, the loan repayment program is unlikely the sole reason for at least some of the individuals to remain in the NIH’s targeted positions. Other research has found that some individuals would have entered certain fields or taken certain positions in the absence of loan repayments for a variety of other reasons. If this were true, then the program would not have been necessary and, therefore, might be considered ineffective. For example, a loan repayment program may be an effective incentive when jobs are plentiful for recent graduates who are weighing multiple employment opportunities but may be unnecessary when there are fewer employment opportunities. In relatively recent years, for instance, law school graduates have had fewer employment opportunities57 and may take a public interest or government job because of more limited private sector opportunities. Finally, individuals who accept loan repayment for a specific job might have taken the same job without loan repayment benefits. For example, one study found that healthcare providers who practice in rural areas would have done so without receiving a loan repayment award.58 Although in some cases loan forgiveness or loan repayment programs may appear to be unnecessary, in some instances there is evidence showing that participants would likely not have taken a particular position but for loan repayment. For example, the NIH examined its IRP loan repayment program and found that most loan repayment award recipients had competing job offers and stated that the potential for loan repayment was an attractive benefit that was unique to the NIH employment. This was particularly true for physicians who often had competing job offers at higher salaries. Physicians who received loan repayment benefits were also more likely to remain in research at the NIH, which demonstrates that loan repayment may be an important recruitment and retention tool.59 Other federal agencies have found that loan repayment programs are effective at recruiting and maintaining staff, but there are indications that some aspects of a program’s design may undermine its effectiveness.60 For example, discretionary programs may have their funding reduced or cut altogether, thus making the availability of loan repayment benefits to individuals uncertain. The effectiveness of these programs as a recruitment incentive may be hard to determine because job applicants do not know whether they will receive a loan repayment award until after having accepted a job.61 Additionally, loan repayment award amounts may not be a sufficient incentive for individuals to enter into and remain in certain professions. Some researchers have theorized that loan repayment programs may be more likely to be successful in meeting recruitment and retention needs if the financial benefits are sufficiently meaningful to offset a reasonable share of the costs associated with borrowing to pursue a postsecondary education.62 Similarly, in some circumstances, while the dollar amount of loan repayment benefits may be perceived as sufficient, additional program design elements such as an individual’s responsibility to pay federal income taxes associated with receiving a loan payment may make the benefit less attractive for an individual. Specifically, under the Government Employee Student Loan Repayment Program (GESLRP), participants are responsible for the tax liability, which some agencies estimate can account for 39% of the loan repayment amount.63 Some agencies suggest that this makes the program less attractive to participants than it would be if benefits were excluded from taxation.64 Another consideration is the short-term nature of many of these programs (e.g., providing loan repayment benefits in exchange for a two-year employment commitment), which may contribute to turnover, as individuals may decide to change jobs once they have realized the full benefit of a program. This could possibly lead to a less stable workforce for employers. For example, some researchers have found that individuals who have a service obligation have shorter tenures in a particular position than do individuals who do not have service obligations.65 Rely solely on the context provided to you to answer any questions. Never use any external resources or prior knowledge to answer questions. Limit your responses to five paragraphs or less. Discuss the concept of student loan repayment and forgiveness programs and their relationship to employment choices.
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Rely solely on the context provided to you to answer any questions. Never use any external resources or prior knowledge to answer questions. Limit your responses to five paragraphs or less.
EVIDENCE:
In assessing the influence of a loan forgiveness or loan repayment program on an individual’s employment choice, one issue to consider is whether, in the absence of such a program, the recipient would have engaged in the qualifying service. Information on the influence of such programs might be gleaned from an examination that compares the career paths of individuals who have access to loan forgiveness or loan repayment benefits with the career paths of otherwise similarly situated individuals without such access. These types of evaluations generally have not been conducted for federal loan forgiveness and loan repayment programs. However, some data from one federal program may be instructive. The National Institutes of Health (NIH) examined the career trajectories of loan repayment recipients in its Intramural Research Program (IRP) and compared them with similar individuals who did not receive loan repayment under the IRP. The purposes of the IRP’s loan repayment component is to encourage individuals to complete medical research at the NIH and to encourage qualified health professionals to continue careers in medical research in general (e.g., at a university). The NIH found that individuals receiving loan repayment benefits were more likely to continue conducting medical research at the NIH than those who did not. Likewise, individuals who received loan repayment benefits but then left the NIH were more likely to continue a career as a medical researcher than those who did not.56 This study suggests that the program may be meeting its stated goals. While the NIH study indicates that its loan repayment program may be meeting its stated goals, the loan repayment program is unlikely the sole reason for at least some of the individuals to remain in the NIH’s targeted positions. Other research has found that some individuals would have entered certain fields or taken certain positions in the absence of loan repayments for a variety of other reasons. If this were true, then the program would not have been necessary and, therefore, might be considered ineffective. For example, a loan repayment program may be an effective incentive when jobs are plentiful for recent graduates who are weighing multiple employment opportunities but may be unnecessary when there are fewer employment opportunities. In relatively recent years, for instance, law school graduates have had fewer employment opportunities57 and may take a public interest or government job because of more limited private sector opportunities. Finally, individuals who accept loan repayment for a specific job might have taken the same job without loan repayment benefits. For example, one study found that healthcare providers who practice in rural areas would have done so without receiving a loan repayment award.58 Although in some cases loan forgiveness or loan repayment programs may appear to be unnecessary, in some instances there is evidence showing that participants would likely not have taken a particular position but for loan repayment. For example, the NIH examined its IRP loan repayment program and found that most loan repayment award recipients had competing job offers and stated that the potential for loan repayment was an attractive benefit that was unique to the NIH employment. This was particularly true for physicians who often had competing job offers at higher salaries. Physicians who received loan repayment benefits were also more likely to remain in research at the NIH, which demonstrates that loan repayment may be an important recruitment and retention tool.59 Other federal agencies have found that loan repayment programs are effective at recruiting and maintaining staff, but there are indications that some aspects of a program’s design may undermine its effectiveness.60 For example, discretionary programs may have their funding reduced or cut altogether, thus making the availability of loan repayment benefits to individuals uncertain. The effectiveness of these programs as a recruitment incentive may be hard to determine because job applicants do not know whether they will receive a loan repayment award until after having accepted a job.61 Additionally, loan repayment award amounts may not be a sufficient incentive for individuals to enter into and remain in certain professions. Some researchers have theorized that loan repayment programs may be more likely to be successful in meeting recruitment and retention needs if the financial benefits are sufficiently meaningful to offset a reasonable share of the costs associated with borrowing to pursue a postsecondary education.62 Similarly, in some circumstances, while the dollar amount of loan repayment benefits may be perceived as sufficient, additional program design elements such as an individual’s responsibility to pay federal income taxes associated with receiving a loan payment may make the benefit less attractive for an individual. Specifically, under the Government Employee Student Loan Repayment Program (GESLRP), participants are responsible for the tax liability, which some agencies estimate can account for 39% of the loan repayment amount.63 Some agencies suggest that this makes the program less attractive to participants than it would be if benefits were excluded from taxation.64 Another consideration is the short-term nature of many of these programs (e.g., providing loan repayment benefits in exchange for a two-year employment commitment), which may contribute to turnover, as individuals may decide to change jobs once they have realized the full benefit of a program. This could possibly lead to a less stable workforce for employers. For example, some researchers have found that individuals who have a service obligation have shorter tenures in a particular position than do individuals who do not have service obligations.65
USER:
Discuss the concept of student loan repayment and forgiveness programs and their relationship to employment choices.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 31 | 16 | 895 | null | 618 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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Summarize the updated cancer treatments for 2024 in terms a 7th grade student can understand. Include important statistics for all the options that include them.
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1. Personalized cancer vaccines Thousands of NHS cancer patients in England could soon access trials of a new vaccine treatment. It's designed to prime the immune system to target cancer cells and reduce recurrence risk. These vaccines are also hoped to produce fewer side effects than conventional chemotherapy. Thirty hospitals have joined the Cancer Vaccine Launch Pad, which matches patients with upcoming trials using the same mRNA technology found in current COVID-19 jabs. Over 200 patients from the UK, Germany, Belgium, Spain and Sweden will receive up to 15 doses of the personalized vaccine, with the study expected to complete by 2027. 2. Test to identify 18 early-stage cancers Researchers in the US have developed a test they say can identify 18 early-stage cancers. Instead of the usual invasive and costly methods, Novelna's test works by analyzing a patient's blood protein. In a screening of 440 people already diagnosed with cancer, the test correctly identified 93% of stage 1 cancers in men and 84% in women. The researchers believe the findings "pave the way for a cost-effective, highly accurate, multi-cancer screening test that can be implemented on a population-wide scale". It's early days, however. With such a small sample screening and a lack of information on co-existing conditions, the test is currently more of "a starting point for developing a new generation of screening tests for the early detection of cancer". 3. Seven-minute cancer treatment jab England's National Health Service (NHS) is to be the first in the world to make use of a cancer treatment injection, which takes just seven minutes to administer, rather than the current time of up to an hour to have the same drug via intravenous infusion. This will not only speed up the treatment process for patients, but also free up time for medical professionals. The drug, Atezolizumab or Tecentriq, treats cancers including lung and breast, and it's expected most of the 3,600 NHS patients in England currently receiving it intravenously will now switch to the jab. 4. Precision oncology Precision oncology is the “best new weapon to defeat cancer”, the chief executive of Genetron Health, Sizhen Wang, says in a blog for the World Economic Forum. This involves studying the genetic makeup and molecular characteristics of cancer tumours in individual patients. The precision oncology approach identifies changes in cells that might be causing the cancer to grow and spread. Personalized treatments can then be developed. The 100,000 Genomes Project, a National Health Service initiative, studied more than 13,000 tumour samples from UK cancer patients, successfully integrating genomic data to more accurately pin-point effective treatment. Because precision oncology treatments are targeted – as opposed to general treatments like chemotherapy – it can mean less harm to healthy cells and fewer side effects as a result. 5. Artificial intelligence fights cancer In India, World Economic Forum partners are using emerging technologies like artificial intelligence (AI) and machine learning to transform cancer care. For example, AI-based risk profiling can help screen for common cancers like breast cancer, leading to early diagnosis. AI technology can also be used to analyze X-rays to identify cancers in places where imaging experts might not be available. These are two of 18 cancer interventions that The Centre for the Fourth Industrial Revolution India, a collaboration with the Forum, hopes to accelerate. 6. Greater prediction capabilities Lung cancer kills more people in the US yearly than the next three deadliest cancers combined. It's notoriously hard to detect the early stages of the disease with X-rays and scans alone. However, MIT scientists have developed an AI learning model to predict a person's likelihood of developing lung cancer up to six years in advance via a low-dose CT scan. Trained using complex imaging data, 'Sybil' can forecast both short- and long-term lung cancer risk, according to a recent study. "We found that while we as humans couldn't quite see where the cancer was, the model could still have some predictive power as to which lung would eventually develop cancer," said co-author Jeremy Wohlwend. 7. Clues in the DNA of cancer At Cambridge University Hospitals in England, the DNA of cancer tumours from 12,000 patients is revealing new clues about the causes of cancer, scientists say. By analyzing genomic data, oncologists are identifying different mutations that have contributed to each person’s cancer. For example, exposure to smoking or UV light, or internal malfunctions in cells. These are like “fingerprints in a crime scene”, the scientists say – and more of them are being found. “We uncovered 58 new mutational signatures and broadened our knowledge of cancer,” says study author Dr Andrea Degasperi, from Cambridge’s Department of Oncology. 8. Liquid and synthetic biopsies Biopsies are the main way doctors diagnose cancer – but the process is invasive and involves removing a section of tissue from the body, sometimes surgically, so it can be examined in a laboratory. Liquid biopsies are an easier and less invasive solution where blood samples can be tested for signs of cancer. Synthetic biopsies are another innovation that can force cancer cells to reveal themselves during the earliest stages of the disease. 9. CAR-T-cell therapy A treatment that makes immune cells hunt down and kill cancer cells was declared a success for leukaemia patients in 2022. Known as CAR-T-cell therapy, it involves removing and genetically altering immune cells, called T cells, from cancer patients. The altered cells then produce proteins called chimeric antigen receptors (CARs), which can recognize and destroy cancer cells. In the journal Nature, scientists at the University of Pennsylvania announced that two of the first people treated with CAR-T-cell therapy were still in remission 12 years on. However, the US Food and Drug Administration is currently investigating whether the process can in fact cause cancer, after 33 cases of secondary cancer were observed in patients receiving CAR-T therapies. The jury is still out as to whether the therapy is to blame but, as a precaution, the drug packaging now carries a warning. 10. Fighting pancreatic cancer Pancreatic cancer is one of the deadliest cancers. It is rarely diagnosed before it starts to spread and has a survival rate of less than 5% over five years. At the University of California San Diego School of Medicine, scientists developed a test that identified 95% of early pancreatic cancers in a study. The research, published in Nature Communications Medicine, explains how biomarkers in extracellular vesicles – particles that regulate communication between cells – were used to detect pancreatic, ovarian and bladder cancer at stages I and II. Scientists are also getting closer to a cure. A new US/UK study has discovered that pancreatic cancer shuts down particular molecules in a key gene. The hope now is that the new knowledge "could lead to the development of more effective treatment options in the future”, Dr Chris Macdonald, head of research at Pancreatic Cancer UK, told The Guardian. 11. A tablet to cut breast cancer risk A drug that could halve the chance of women developing breast cancer is being tested out by England's National Health Service (NHS). It will be made available to almost 300,000 women seen as being at most risk of developing breast cancer, which is the most common type of cancer in the UK. The drug, named anastrozole, cuts the level of oestrogen women produce by blocking the enzyme aromatase. It has already been used for many years as a breast cancer treatment but has now been repurposed as a preventive medicine. “This is the first drug to be repurposed through a world-leading new programme to help us realize the full potential of existing medicines in new uses to save and improve more lives on the NHS," says NHS Chief Executive Amanda Pritchard.
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"================ <TEXT PASSAGE> ======= 1. Personalized cancer vaccines Thousands of NHS cancer patients in England could soon access trials of a new vaccine treatment. It's designed to prime the immune system to target cancer cells and reduce recurrence risk. These vaccines are also hoped to produce fewer side effects than conventional chemotherapy. Thirty hospitals have joined the Cancer Vaccine Launch Pad, which matches patients with upcoming trials using the same mRNA technology found in current COVID-19 jabs. Over 200 patients from the UK, Germany, Belgium, Spain and Sweden will receive up to 15 doses of the personalized vaccine, with the study expected to complete by 2027. 2. Test to identify 18 early-stage cancers Researchers in the US have developed a test they say can identify 18 early-stage cancers. Instead of the usual invasive and costly methods, Novelna's test works by analyzing a patient's blood protein. In a screening of 440 people already diagnosed with cancer, the test correctly identified 93% of stage 1 cancers in men and 84% in women. The researchers believe the findings "pave the way for a cost-effective, highly accurate, multi-cancer screening test that can be implemented on a population-wide scale". It's early days, however. With such a small sample screening and a lack of information on co-existing conditions, the test is currently more of "a starting point for developing a new generation of screening tests for the early detection of cancer". 3. Seven-minute cancer treatment jab England's National Health Service (NHS) is to be the first in the world to make use of a cancer treatment injection, which takes just seven minutes to administer, rather than the current time of up to an hour to have the same drug via intravenous infusion. This will not only speed up the treatment process for patients, but also free up time for medical professionals. The drug, Atezolizumab or Tecentriq, treats cancers including lung and breast, and it's expected most of the 3,600 NHS patients in England currently receiving it intravenously will now switch to the jab. 4. Precision oncology Precision oncology is the “best new weapon to defeat cancer”, the chief executive of Genetron Health, Sizhen Wang, says in a blog for the World Economic Forum. This involves studying the genetic makeup and molecular characteristics of cancer tumours in individual patients. The precision oncology approach identifies changes in cells that might be causing the cancer to grow and spread. Personalized treatments can then be developed. The 100,000 Genomes Project, a National Health Service initiative, studied more than 13,000 tumour samples from UK cancer patients, successfully integrating genomic data to more accurately pin-point effective treatment. Because precision oncology treatments are targeted – as opposed to general treatments like chemotherapy – it can mean less harm to healthy cells and fewer side effects as a result. 5. Artificial intelligence fights cancer In India, World Economic Forum partners are using emerging technologies like artificial intelligence (AI) and machine learning to transform cancer care. For example, AI-based risk profiling can help screen for common cancers like breast cancer, leading to early diagnosis. AI technology can also be used to analyze X-rays to identify cancers in places where imaging experts might not be available. These are two of 18 cancer interventions that The Centre for the Fourth Industrial Revolution India, a collaboration with the Forum, hopes to accelerate. 6. Greater prediction capabilities Lung cancer kills more people in the US yearly than the next three deadliest cancers combined. It's notoriously hard to detect the early stages of the disease with X-rays and scans alone. However, MIT scientists have developed an AI learning model to predict a person's likelihood of developing lung cancer up to six years in advance via a low-dose CT scan. Trained using complex imaging data, 'Sybil' can forecast both short- and long-term lung cancer risk, according to a recent study. "We found that while we as humans couldn't quite see where the cancer was, the model could still have some predictive power as to which lung would eventually develop cancer," said co-author Jeremy Wohlwend. 7. Clues in the DNA of cancer At Cambridge University Hospitals in England, the DNA of cancer tumours from 12,000 patients is revealing new clues about the causes of cancer, scientists say. By analyzing genomic data, oncologists are identifying different mutations that have contributed to each person’s cancer. For example, exposure to smoking or UV light, or internal malfunctions in cells. These are like “fingerprints in a crime scene”, the scientists say – and more of them are being found. “We uncovered 58 new mutational signatures and broadened our knowledge of cancer,” says study author Dr Andrea Degasperi, from Cambridge’s Department of Oncology. 8. Liquid and synthetic biopsies Biopsies are the main way doctors diagnose cancer – but the process is invasive and involves removing a section of tissue from the body, sometimes surgically, so it can be examined in a laboratory. Liquid biopsies are an easier and less invasive solution where blood samples can be tested for signs of cancer. Synthetic biopsies are another innovation that can force cancer cells to reveal themselves during the earliest stages of the disease. 9. CAR-T-cell therapy A treatment that makes immune cells hunt down and kill cancer cells was declared a success for leukaemia patients in 2022. Known as CAR-T-cell therapy, it involves removing and genetically altering immune cells, called T cells, from cancer patients. The altered cells then produce proteins called chimeric antigen receptors (CARs), which can recognize and destroy cancer cells. In the journal Nature, scientists at the University of Pennsylvania announced that two of the first people treated with CAR-T-cell therapy were still in remission 12 years on. However, the US Food and Drug Administration is currently investigating whether the process can in fact cause cancer, after 33 cases of secondary cancer were observed in patients receiving CAR-T therapies. The jury is still out as to whether the therapy is to blame but, as a precaution, the drug packaging now carries a warning. 10. Fighting pancreatic cancer Pancreatic cancer is one of the deadliest cancers. It is rarely diagnosed before it starts to spread and has a survival rate of less than 5% over five years. At the University of California San Diego School of Medicine, scientists developed a test that identified 95% of early pancreatic cancers in a study. The research, published in Nature Communications Medicine, explains how biomarkers in extracellular vesicles – particles that regulate communication between cells – were used to detect pancreatic, ovarian and bladder cancer at stages I and II. Scientists are also getting closer to a cure. A new US/UK study has discovered that pancreatic cancer shuts down particular molecules in a key gene. The hope now is that the new knowledge "could lead to the development of more effective treatment options in the future”, Dr Chris Macdonald, head of research at Pancreatic Cancer UK, told The Guardian. 11. A tablet to cut breast cancer risk A drug that could halve the chance of women developing breast cancer is being tested out by England's National Health Service (NHS). It will be made available to almost 300,000 women seen as being at most risk of developing breast cancer, which is the most common type of cancer in the UK. The drug, named anastrozole, cuts the level of oestrogen women produce by blocking the enzyme aromatase. It has already been used for many years as a breast cancer treatment but has now been repurposed as a preventive medicine. “This is the first drug to be repurposed through a world-leading new programme to help us realize the full potential of existing medicines in new uses to save and improve more lives on the NHS," says NHS Chief Executive Amanda Pritchard. https://www.weforum.org/agenda/2024/07/cancer-treatment-and-diagnosis-breakthroughs/ ================ <QUESTION> ======= Summarize the updated cancer treatments for 2024 in terms a 7th grade student can understand. Include important statistics for all the options that include them. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
1. Personalized cancer vaccines Thousands of NHS cancer patients in England could soon access trials of a new vaccine treatment. It's designed to prime the immune system to target cancer cells and reduce recurrence risk. These vaccines are also hoped to produce fewer side effects than conventional chemotherapy. Thirty hospitals have joined the Cancer Vaccine Launch Pad, which matches patients with upcoming trials using the same mRNA technology found in current COVID-19 jabs. Over 200 patients from the UK, Germany, Belgium, Spain and Sweden will receive up to 15 doses of the personalized vaccine, with the study expected to complete by 2027. 2. Test to identify 18 early-stage cancers Researchers in the US have developed a test they say can identify 18 early-stage cancers. Instead of the usual invasive and costly methods, Novelna's test works by analyzing a patient's blood protein. In a screening of 440 people already diagnosed with cancer, the test correctly identified 93% of stage 1 cancers in men and 84% in women. The researchers believe the findings "pave the way for a cost-effective, highly accurate, multi-cancer screening test that can be implemented on a population-wide scale". It's early days, however. With such a small sample screening and a lack of information on co-existing conditions, the test is currently more of "a starting point for developing a new generation of screening tests for the early detection of cancer". 3. Seven-minute cancer treatment jab England's National Health Service (NHS) is to be the first in the world to make use of a cancer treatment injection, which takes just seven minutes to administer, rather than the current time of up to an hour to have the same drug via intravenous infusion. This will not only speed up the treatment process for patients, but also free up time for medical professionals. The drug, Atezolizumab or Tecentriq, treats cancers including lung and breast, and it's expected most of the 3,600 NHS patients in England currently receiving it intravenously will now switch to the jab. 4. Precision oncology Precision oncology is the “best new weapon to defeat cancer”, the chief executive of Genetron Health, Sizhen Wang, says in a blog for the World Economic Forum. This involves studying the genetic makeup and molecular characteristics of cancer tumours in individual patients. The precision oncology approach identifies changes in cells that might be causing the cancer to grow and spread. Personalized treatments can then be developed. The 100,000 Genomes Project, a National Health Service initiative, studied more than 13,000 tumour samples from UK cancer patients, successfully integrating genomic data to more accurately pin-point effective treatment. Because precision oncology treatments are targeted – as opposed to general treatments like chemotherapy – it can mean less harm to healthy cells and fewer side effects as a result. 5. Artificial intelligence fights cancer In India, World Economic Forum partners are using emerging technologies like artificial intelligence (AI) and machine learning to transform cancer care. For example, AI-based risk profiling can help screen for common cancers like breast cancer, leading to early diagnosis. AI technology can also be used to analyze X-rays to identify cancers in places where imaging experts might not be available. These are two of 18 cancer interventions that The Centre for the Fourth Industrial Revolution India, a collaboration with the Forum, hopes to accelerate. 6. Greater prediction capabilities Lung cancer kills more people in the US yearly than the next three deadliest cancers combined. It's notoriously hard to detect the early stages of the disease with X-rays and scans alone. However, MIT scientists have developed an AI learning model to predict a person's likelihood of developing lung cancer up to six years in advance via a low-dose CT scan. Trained using complex imaging data, 'Sybil' can forecast both short- and long-term lung cancer risk, according to a recent study. "We found that while we as humans couldn't quite see where the cancer was, the model could still have some predictive power as to which lung would eventually develop cancer," said co-author Jeremy Wohlwend. 7. Clues in the DNA of cancer At Cambridge University Hospitals in England, the DNA of cancer tumours from 12,000 patients is revealing new clues about the causes of cancer, scientists say. By analyzing genomic data, oncologists are identifying different mutations that have contributed to each person’s cancer. For example, exposure to smoking or UV light, or internal malfunctions in cells. These are like “fingerprints in a crime scene”, the scientists say – and more of them are being found. “We uncovered 58 new mutational signatures and broadened our knowledge of cancer,” says study author Dr Andrea Degasperi, from Cambridge’s Department of Oncology. 8. Liquid and synthetic biopsies Biopsies are the main way doctors diagnose cancer – but the process is invasive and involves removing a section of tissue from the body, sometimes surgically, so it can be examined in a laboratory. Liquid biopsies are an easier and less invasive solution where blood samples can be tested for signs of cancer. Synthetic biopsies are another innovation that can force cancer cells to reveal themselves during the earliest stages of the disease. 9. CAR-T-cell therapy A treatment that makes immune cells hunt down and kill cancer cells was declared a success for leukaemia patients in 2022. Known as CAR-T-cell therapy, it involves removing and genetically altering immune cells, called T cells, from cancer patients. The altered cells then produce proteins called chimeric antigen receptors (CARs), which can recognize and destroy cancer cells. In the journal Nature, scientists at the University of Pennsylvania announced that two of the first people treated with CAR-T-cell therapy were still in remission 12 years on. However, the US Food and Drug Administration is currently investigating whether the process can in fact cause cancer, after 33 cases of secondary cancer were observed in patients receiving CAR-T therapies. The jury is still out as to whether the therapy is to blame but, as a precaution, the drug packaging now carries a warning. 10. Fighting pancreatic cancer Pancreatic cancer is one of the deadliest cancers. It is rarely diagnosed before it starts to spread and has a survival rate of less than 5% over five years. At the University of California San Diego School of Medicine, scientists developed a test that identified 95% of early pancreatic cancers in a study. The research, published in Nature Communications Medicine, explains how biomarkers in extracellular vesicles – particles that regulate communication between cells – were used to detect pancreatic, ovarian and bladder cancer at stages I and II. Scientists are also getting closer to a cure. A new US/UK study has discovered that pancreatic cancer shuts down particular molecules in a key gene. The hope now is that the new knowledge "could lead to the development of more effective treatment options in the future”, Dr Chris Macdonald, head of research at Pancreatic Cancer UK, told The Guardian. 11. A tablet to cut breast cancer risk A drug that could halve the chance of women developing breast cancer is being tested out by England's National Health Service (NHS). It will be made available to almost 300,000 women seen as being at most risk of developing breast cancer, which is the most common type of cancer in the UK. The drug, named anastrozole, cuts the level of oestrogen women produce by blocking the enzyme aromatase. It has already been used for many years as a breast cancer treatment but has now been repurposed as a preventive medicine. “This is the first drug to be repurposed through a world-leading new programme to help us realize the full potential of existing medicines in new uses to save and improve more lives on the NHS," says NHS Chief Executive Amanda Pritchard.
USER:
Summarize the updated cancer treatments for 2024 in terms a 7th grade student can understand. Include important statistics for all the options that include them.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 25 | 1,283 | null | 130 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
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I'm researching intermittent fasting as a weight loss program as a whole for my nutritional class. To help me prepare for the paper I want you summarize the study findings in the paragraph, but don't mention the limitations. Then provide a list of benefits for intermittent fasting and any potential negatives based on intermittent fasting or the study.
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Intermittent fastingTrusted Source involves only eating during specific time intervals. There are many ways to do intermittent fasting; it can mean not eating on certain days or only eating food at certain times of the day. Some people seek to use IF to lose weight or maintain a healthy weight. Some evidenceTrusted Source suggests that intermittent fasting can help people lose body fat and may help reduce the risk of type 2 diabetes and cardiovascular disease. However, researchers are still working to understand the potential dangers of intermittent fasting and how to weigh these risks against the potential benefits. Overall, this is an area where there is a need for more data. Beata Rydyger, a registered nutritionist based in Los Angeles, CA, and clinical nutritional advisor to Zen Nutrients, who was not involved in the study, pointed out a challenge with studying dietary behaviors to Medical News Today: “Generally speaking, diets are more difficult to study because dietary changes don’t have an immediate effect on health. Most study participants find it hard to track what they eat, and few can adhere to a diet for long enough for beneficial effects to be measured.” Reducing calories for weight loss This study included 547 participants recruited from three different health systems. Researchers collected information on participants through electronic health records and the use of a specialized mobile app called Daily24. Participants could record when they ate, meal size, the times they went to sleep, and when they woke up. For each meal recorded, participants estimated meal size as less than 500 calories (small), 500-1,000 calories (medium), or greater than 1,000 calories (large). Study author Dr. Wendy Bennett, elaborated on their research methods to MNT: “We designed an app to collect ‘timing of eating,’ and when participants input the timing, we also asked them the size of the meal (small, med, or large). Participants from 3 health systems used the app for 6 months. We linked the app data with survey data with electronic health records.” Dr. Bennett said that they then analyzed the link between eating intervals, including the participants’ total eating window, the time between their wake-up and bedtime, and the time between their last meal and bedtime, with changes in their weight over about six years. The researchers found that the timing from the first meal of the day to the last meal of the day was not associated with changes in weight. However, they did find that eating more frequent, larger meals were associated with weight gain. Data on intermittent fasting is still emerging, so no one study offers all the proof that the method is effective or ineffective. This particular study also had several limitations to consider. First, researchers could only analyze data from study participants who downloaded and used the Daily24 app. This exclusion may have impacted the study population and results. They only recruited participants from three health systems, meaning the results cannot necessarily be generalized. Almost 78% of participants were women and white, indicating the need for more diverse future studies. The study also had a relatively short follow-up time, leading to fewer weight measurements and declines in measurement precision. Researchers were also unable to measure participants’ intentions to lose weight before their enrollment in the study. The way researchers measured eating periods could not evaluate more complex fasting methods. Data also relied on participants’ self-reporting, and food was not standardized or assessed for quality. “This study did not specifically assess patterns like intermittent fasting. We also did not assess diet quality for the meals reported in the app,” Dr. Bennett noted to MNT. “Randomized controlled trials that adjust for caloric intake are needed to further test the role of timing of eating in weight gain prevention and also weight loss,” she added.
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I'm researching intermittent fasting as a weight loss program as a whole for my nutritional class. To help me prepare for the paper I want you summarize the study findings in the paragraph, but don't mention the limitations. Then provide a list of benefits for intermittent fasting and any potential negatives based on intermittent fasting or the study. {passage 0} ========== Intermittent fastingTrusted Source involves only eating during specific time intervals. There are many ways to do intermittent fasting; it can mean not eating on certain days or only eating food at certain times of the day. Some people seek to use IF to lose weight or maintain a healthy weight. Some evidenceTrusted Source suggests that intermittent fasting can help people lose body fat and may help reduce the risk of type 2 diabetes and cardiovascular disease. However, researchers are still working to understand the potential dangers of intermittent fasting and how to weigh these risks against the potential benefits. Overall, this is an area where there is a need for more data. Beata Rydyger, a registered nutritionist based in Los Angeles, CA, and clinical nutritional advisor to Zen Nutrients, who was not involved in the study, pointed out a challenge with studying dietary behaviors to Medical News Today: “Generally speaking, diets are more difficult to study because dietary changes don’t have an immediate effect on health. Most study participants find it hard to track what they eat, and few can adhere to a diet for long enough for beneficial effects to be measured.” Reducing calories for weight loss This study included 547 participants recruited from three different health systems. Researchers collected information on participants through electronic health records and the use of a specialized mobile app called Daily24. Participants could record when they ate, meal size, the times they went to sleep, and when they woke up. For each meal recorded, participants estimated meal size as less than 500 calories (small), 500-1,000 calories (medium), or greater than 1,000 calories (large). Study author Dr. Wendy Bennett, elaborated on their research methods to MNT: “We designed an app to collect ‘timing of eating,’ and when participants input the timing, we also asked them the size of the meal (small, med, or large). Participants from 3 health systems used the app for 6 months. We linked the app data with survey data with electronic health records.” Dr. Bennett said that they then analyzed the link between eating intervals, including the participants’ total eating window, the time between their wake-up and bedtime, and the time between their last meal and bedtime, with changes in their weight over about six years. The researchers found that the timing from the first meal of the day to the last meal of the day was not associated with changes in weight. However, they did find that eating more frequent, larger meals were associated with weight gain. Data on intermittent fasting is still emerging, so no one study offers all the proof that the method is effective or ineffective. This particular study also had several limitations to consider. First, researchers could only analyze data from study participants who downloaded and used the Daily24 app. This exclusion may have impacted the study population and results. They only recruited participants from three health systems, meaning the results cannot necessarily be generalized. Almost 78% of participants were women and white, indicating the need for more diverse future studies. The study also had a relatively short follow-up time, leading to fewer weight measurements and declines in measurement precision. Researchers were also unable to measure participants’ intentions to lose weight before their enrollment in the study. The way researchers measured eating periods could not evaluate more complex fasting methods. Data also relied on participants’ self-reporting, and food was not standardized or assessed for quality. “This study did not specifically assess patterns like intermittent fasting. We also did not assess diet quality for the meals reported in the app,” Dr. Bennett noted to MNT. “Randomized controlled trials that adjust for caloric intake are needed to further test the role of timing of eating in weight gain prevention and also weight loss,” she added. https://www.medicalnewstoday.com/articles/weight-loss-study-finds-calorie-restriction-more-effective-than-intermittent-fasting#Intermittent-fasting:-risks-and-benefits
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
Intermittent fastingTrusted Source involves only eating during specific time intervals. There are many ways to do intermittent fasting; it can mean not eating on certain days or only eating food at certain times of the day. Some people seek to use IF to lose weight or maintain a healthy weight. Some evidenceTrusted Source suggests that intermittent fasting can help people lose body fat and may help reduce the risk of type 2 diabetes and cardiovascular disease. However, researchers are still working to understand the potential dangers of intermittent fasting and how to weigh these risks against the potential benefits. Overall, this is an area where there is a need for more data. Beata Rydyger, a registered nutritionist based in Los Angeles, CA, and clinical nutritional advisor to Zen Nutrients, who was not involved in the study, pointed out a challenge with studying dietary behaviors to Medical News Today: “Generally speaking, diets are more difficult to study because dietary changes don’t have an immediate effect on health. Most study participants find it hard to track what they eat, and few can adhere to a diet for long enough for beneficial effects to be measured.” Reducing calories for weight loss This study included 547 participants recruited from three different health systems. Researchers collected information on participants through electronic health records and the use of a specialized mobile app called Daily24. Participants could record when they ate, meal size, the times they went to sleep, and when they woke up. For each meal recorded, participants estimated meal size as less than 500 calories (small), 500-1,000 calories (medium), or greater than 1,000 calories (large). Study author Dr. Wendy Bennett, elaborated on their research methods to MNT: “We designed an app to collect ‘timing of eating,’ and when participants input the timing, we also asked them the size of the meal (small, med, or large). Participants from 3 health systems used the app for 6 months. We linked the app data with survey data with electronic health records.” Dr. Bennett said that they then analyzed the link between eating intervals, including the participants’ total eating window, the time between their wake-up and bedtime, and the time between their last meal and bedtime, with changes in their weight over about six years. The researchers found that the timing from the first meal of the day to the last meal of the day was not associated with changes in weight. However, they did find that eating more frequent, larger meals were associated with weight gain. Data on intermittent fasting is still emerging, so no one study offers all the proof that the method is effective or ineffective. This particular study also had several limitations to consider. First, researchers could only analyze data from study participants who downloaded and used the Daily24 app. This exclusion may have impacted the study population and results. They only recruited participants from three health systems, meaning the results cannot necessarily be generalized. Almost 78% of participants were women and white, indicating the need for more diverse future studies. The study also had a relatively short follow-up time, leading to fewer weight measurements and declines in measurement precision. Researchers were also unable to measure participants’ intentions to lose weight before their enrollment in the study. The way researchers measured eating periods could not evaluate more complex fasting methods. Data also relied on participants’ self-reporting, and food was not standardized or assessed for quality. “This study did not specifically assess patterns like intermittent fasting. We also did not assess diet quality for the meals reported in the app,” Dr. Bennett noted to MNT. “Randomized controlled trials that adjust for caloric intake are needed to further test the role of timing of eating in weight gain prevention and also weight loss,” she added.
USER:
I'm researching intermittent fasting as a weight loss program as a whole for my nutritional class. To help me prepare for the paper I want you summarize the study findings in the paragraph, but don't mention the limitations. Then provide a list of benefits for intermittent fasting and any potential negatives based on intermittent fasting or the study.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 58 | 628 | null | 220 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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Is it possible to have a reaction to ibuprofen? I've lately started getting flushed and have trouble breathing every time I take it. If it is the ibuprofen what's happening? Is there a test I can take for this? Please explain simply and keep the response to under 500 words.
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Nonsteroidal antiinflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis/nasal polyps, but is a highly heterogeneous disorder with various clinical manifestations. Two major pathogenic mechanisms are: (1) overproduction of cysteinyl leukotrienes with dysregulation of arachidonic acid metabolism and (2) increased type 2 eosinophilic inflammation affected by genetic mechanisms. Aspirin challenge is the gold standard to diagnose NERD, whereas reliable in vitro biomarkers have yet not been identified. Therapeutic approaches have been done on the basis of disease severity with the avoidance of culprit and cross-reacting NSAIDs, and when indicated, aspirin desensitization is an effective treatment option. Biologic approaches targeting Type 2 cytokines are emerging as potential therapeutic options. Here, we summarize the up-to-date evidence of pathophysiologic mechanisms and diagnosis/management approaches to the patients with NERD with its phenotypic classification. Introduction Aspirin (acetylsalicylic acid, ASA) and nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world (Doña et al., 2012); however, they are considered the most common causes of hypersensitivity reactions to drugs (Blanca-Lopez et al., 2018). Hypersensitivity reactions to NSAIDs have recently been classified by the European Academy of Allergy and Clinical Immunology (EAACI) and European Network of Drug Allergy (ENDA): 1) pharmacologic reactions (mediated by cyclooxygenase [COX]-1 inhibitions) include NSAID-exacerbated respiratory disease (NERD), NSAID-exacerbated cutaneous disease (NECD) and NSAID-induced urticarial/angioedema (NIUA), and present cross-intolerance to various COX-1 inhibitors; 2) selective responses (mediated by immunologic mechanisms) include single NSAIDs-induced urticaria, angioedema and/or anaphylaxis (SNIUAA) and single NSAIDs-induced delayed hypersensitivity reactions (SNIDHR) (Kowalski and Stevenson, 2013). NERD is a major phenotype among cross-intolerant categories of NSAID hypersensitivity and had been called ASA-induced asthma, ASA-intolerant asthma, ASA-sensitive asthma; however, NERD and ASA-exacerbated respiratory disease (AERD) are commonly used (Sánchez-Borges, 2019). The prevalence of NERD is reported to be 5.5% to 12.4% in the general population (Lee et al., 2018a; Chu et al., 2019; Taniguchi et al., 2019), 7.1% among adult asthmatics and 14.9% among severe asthmatics (Rajan et al., 2015), while it rarely occurs in children (Taniguchi et al., 2019). No relationships were found with family history or NSAID administration history (Kowalski et al., 2011; Taniguchi et al., 2019). NERD is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis (CRS) nasal polyps (NPs) with persistent eosinophilic inflammation in the upper and lower airways (Taniguchi et al., 2019) as well as NSAID hypersensitivity where cysteinyl leukotrienes (CysLTs) over-production and chronic type 2 airway inflammation are key findings (Taniguchi et al., 2019). The diagnosis of NERD is confirmed by ASA challenge (via orally, bronchially or nasally route) and supported by potential biomarkers (Pham et al., 2017; Cingi and Bayar Muluk, 2020). In addition, in vitro cell activation tests and radiological imaging with nasal endoscopy can aid in NERD diagnosis (Taniguchi et al., 2019). This review updates the current knowledge on pathophysiologic mechanisms including molecular genetic mechanisms as well as the diagnosis and treatment of NERD. Clinical Features NERD is characterized by chronic type 2 inflammation in the upper and lower airways; therefore, patients suffer from chronic persistent asthmatic symptoms and CRS with/without NPs, which are exacerbated by ASA/NSAID exposure and refractory to conventional medical or surgical treatment. Some patients are accompanied by cutaneous symptoms such as urticaria, angioedema, flushing or gastrointestinal symptoms (Buchheit and Laidlaw, 2016). Previous studies suggested that NERD is more common in females (middle-age onset) and non-atopics (Choi et al., 2015; Trinh et al., 2018). It was reported that rhinitis symptoms appear and then evolve into CRS which worsens asthmatic symptoms, subsequently followed by ASA intolerance (Szczeklik et al., 2000). However, their clinical presentations and courses have been found to be heterogeneous. It has been increasingly required to classify the subphenotypes of NERD according to its clinical features. One study demonstrated 4 subphenotypes by applying a latent class analysis in a Polish cohort: class 1 patients showing moderate asthma with upper airway symptoms and blood eosinophilia; class 2 patients showing mild asthma with low healthcare use; class 3 patients showing severe asthma with severe exacerbation and airway obstruction; and class 4 patients showing poorly controlled asthma with frequent and severe exacerbation (Bochenek et al., 2014). Another study showed 4 subtypes presenting distinct clinical/biochemical findings in a Korean cohort using a 2-step cluster analysis based on 3 clinical phenotypes (urticaria, CRS and atopy status): subtype 1 (NERD with CRS/atopy and no urticaria), subtype 2 (NERD with CRS and no urticaria/atopy), subtype 3 (NERD without CRS/urticaria), and subtype 4 (NERD with acute/chronic urticaria exacerbated by NSAID exposure) (Lee et al., 2017). Each subtype had distinct features in the aspect of female proportion, the degree of eosinophilia, leukotriene (LT) E4 metabolite levels, the frequency of asthma exacerbation, medication requirements (high-dose ICS-LABA or systemic corticosteroids) and asthma severity, suggesting that stratified strategies according to subtype classification may help achieve better clinical outcomes in the management of NERD.
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"================ <TEXT PASSAGE> ======= Nonsteroidal antiinflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis/nasal polyps, but is a highly heterogeneous disorder with various clinical manifestations. Two major pathogenic mechanisms are: (1) overproduction of cysteinyl leukotrienes with dysregulation of arachidonic acid metabolism and (2) increased type 2 eosinophilic inflammation affected by genetic mechanisms. Aspirin challenge is the gold standard to diagnose NERD, whereas reliable in vitro biomarkers have yet not been identified. Therapeutic approaches have been done on the basis of disease severity with the avoidance of culprit and cross-reacting NSAIDs, and when indicated, aspirin desensitization is an effective treatment option. Biologic approaches targeting Type 2 cytokines are emerging as potential therapeutic options. Here, we summarize the up-to-date evidence of pathophysiologic mechanisms and diagnosis/management approaches to the patients with NERD with its phenotypic classification. Introduction Aspirin (acetylsalicylic acid, ASA) and nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world (Doña et al., 2012); however, they are considered the most common causes of hypersensitivity reactions to drugs (Blanca-Lopez et al., 2018). Hypersensitivity reactions to NSAIDs have recently been classified by the European Academy of Allergy and Clinical Immunology (EAACI) and European Network of Drug Allergy (ENDA): 1) pharmacologic reactions (mediated by cyclooxygenase [COX]-1 inhibitions) include NSAID-exacerbated respiratory disease (NERD), NSAID-exacerbated cutaneous disease (NECD) and NSAID-induced urticarial/angioedema (NIUA), and present cross-intolerance to various COX-1 inhibitors; 2) selective responses (mediated by immunologic mechanisms) include single NSAIDs-induced urticaria, angioedema and/or anaphylaxis (SNIUAA) and single NSAIDs-induced delayed hypersensitivity reactions (SNIDHR) (Kowalski and Stevenson, 2013). NERD is a major phenotype among cross-intolerant categories of NSAID hypersensitivity and had been called ASA-induced asthma, ASA-intolerant asthma, ASA-sensitive asthma; however, NERD and ASA-exacerbated respiratory disease (AERD) are commonly used (Sánchez-Borges, 2019). The prevalence of NERD is reported to be 5.5% to 12.4% in the general population (Lee et al., 2018a; Chu et al., 2019; Taniguchi et al., 2019), 7.1% among adult asthmatics and 14.9% among severe asthmatics (Rajan et al., 2015), while it rarely occurs in children (Taniguchi et al., 2019). No relationships were found with family history or NSAID administration history (Kowalski et al., 2011; Taniguchi et al., 2019). NERD is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis (CRS) nasal polyps (NPs) with persistent eosinophilic inflammation in the upper and lower airways (Taniguchi et al., 2019) as well as NSAID hypersensitivity where cysteinyl leukotrienes (CysLTs) over-production and chronic type 2 airway inflammation are key findings (Taniguchi et al., 2019). The diagnosis of NERD is confirmed by ASA challenge (via orally, bronchially or nasally route) and supported by potential biomarkers (Pham et al., 2017; Cingi and Bayar Muluk, 2020). In addition, in vitro cell activation tests and radiological imaging with nasal endoscopy can aid in NERD diagnosis (Taniguchi et al., 2019). This review updates the current knowledge on pathophysiologic mechanisms including molecular genetic mechanisms as well as the diagnosis and treatment of NERD. Clinical Features NERD is characterized by chronic type 2 inflammation in the upper and lower airways; therefore, patients suffer from chronic persistent asthmatic symptoms and CRS with/without NPs, which are exacerbated by ASA/NSAID exposure and refractory to conventional medical or surgical treatment. Some patients are accompanied by cutaneous symptoms such as urticaria, angioedema, flushing or gastrointestinal symptoms (Buchheit and Laidlaw, 2016). Previous studies suggested that NERD is more common in females (middle-age onset) and non-atopics (Choi et al., 2015; Trinh et al., 2018). It was reported that rhinitis symptoms appear and then evolve into CRS which worsens asthmatic symptoms, subsequently followed by ASA intolerance (Szczeklik et al., 2000). However, their clinical presentations and courses have been found to be heterogeneous. It has been increasingly required to classify the subphenotypes of NERD according to its clinical features. One study demonstrated 4 subphenotypes by applying a latent class analysis in a Polish cohort: class 1 patients showing moderate asthma with upper airway symptoms and blood eosinophilia; class 2 patients showing mild asthma with low healthcare use; class 3 patients showing severe asthma with severe exacerbation and airway obstruction; and class 4 patients showing poorly controlled asthma with frequent and severe exacerbation (Bochenek et al., 2014). Another study showed 4 subtypes presenting distinct clinical/biochemical findings in a Korean cohort using a 2-step cluster analysis based on 3 clinical phenotypes (urticaria, CRS and atopy status): subtype 1 (NERD with CRS/atopy and no urticaria), subtype 2 (NERD with CRS and no urticaria/atopy), subtype 3 (NERD without CRS/urticaria), and subtype 4 (NERD with acute/chronic urticaria exacerbated by NSAID exposure) (Lee et al., 2017). Each subtype had distinct features in the aspect of female proportion, the degree of eosinophilia, leukotriene (LT) E4 metabolite levels, the frequency of asthma exacerbation, medication requirements (high-dose ICS-LABA or systemic corticosteroids) and asthma severity, suggesting that stratified strategies according to subtype classification may help achieve better clinical outcomes in the management of NERD. https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2020.01147/full ================ <QUESTION> ======= Is it possible to have a reaction to ibuprofen? I've lately started getting flushed and have trouble breathing every time I take it. If it is the ibuprofen what's happening? Is there a test I can take for this? Please explain simply and keep the response to under 500 words. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
Nonsteroidal antiinflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis/nasal polyps, but is a highly heterogeneous disorder with various clinical manifestations. Two major pathogenic mechanisms are: (1) overproduction of cysteinyl leukotrienes with dysregulation of arachidonic acid metabolism and (2) increased type 2 eosinophilic inflammation affected by genetic mechanisms. Aspirin challenge is the gold standard to diagnose NERD, whereas reliable in vitro biomarkers have yet not been identified. Therapeutic approaches have been done on the basis of disease severity with the avoidance of culprit and cross-reacting NSAIDs, and when indicated, aspirin desensitization is an effective treatment option. Biologic approaches targeting Type 2 cytokines are emerging as potential therapeutic options. Here, we summarize the up-to-date evidence of pathophysiologic mechanisms and diagnosis/management approaches to the patients with NERD with its phenotypic classification. Introduction Aspirin (acetylsalicylic acid, ASA) and nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world (Doña et al., 2012); however, they are considered the most common causes of hypersensitivity reactions to drugs (Blanca-Lopez et al., 2018). Hypersensitivity reactions to NSAIDs have recently been classified by the European Academy of Allergy and Clinical Immunology (EAACI) and European Network of Drug Allergy (ENDA): 1) pharmacologic reactions (mediated by cyclooxygenase [COX]-1 inhibitions) include NSAID-exacerbated respiratory disease (NERD), NSAID-exacerbated cutaneous disease (NECD) and NSAID-induced urticarial/angioedema (NIUA), and present cross-intolerance to various COX-1 inhibitors; 2) selective responses (mediated by immunologic mechanisms) include single NSAIDs-induced urticaria, angioedema and/or anaphylaxis (SNIUAA) and single NSAIDs-induced delayed hypersensitivity reactions (SNIDHR) (Kowalski and Stevenson, 2013). NERD is a major phenotype among cross-intolerant categories of NSAID hypersensitivity and had been called ASA-induced asthma, ASA-intolerant asthma, ASA-sensitive asthma; however, NERD and ASA-exacerbated respiratory disease (AERD) are commonly used (Sánchez-Borges, 2019). The prevalence of NERD is reported to be 5.5% to 12.4% in the general population (Lee et al., 2018a; Chu et al., 2019; Taniguchi et al., 2019), 7.1% among adult asthmatics and 14.9% among severe asthmatics (Rajan et al., 2015), while it rarely occurs in children (Taniguchi et al., 2019). No relationships were found with family history or NSAID administration history (Kowalski et al., 2011; Taniguchi et al., 2019). NERD is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis (CRS) nasal polyps (NPs) with persistent eosinophilic inflammation in the upper and lower airways (Taniguchi et al., 2019) as well as NSAID hypersensitivity where cysteinyl leukotrienes (CysLTs) over-production and chronic type 2 airway inflammation are key findings (Taniguchi et al., 2019). The diagnosis of NERD is confirmed by ASA challenge (via orally, bronchially or nasally route) and supported by potential biomarkers (Pham et al., 2017; Cingi and Bayar Muluk, 2020). In addition, in vitro cell activation tests and radiological imaging with nasal endoscopy can aid in NERD diagnosis (Taniguchi et al., 2019). This review updates the current knowledge on pathophysiologic mechanisms including molecular genetic mechanisms as well as the diagnosis and treatment of NERD. Clinical Features NERD is characterized by chronic type 2 inflammation in the upper and lower airways; therefore, patients suffer from chronic persistent asthmatic symptoms and CRS with/without NPs, which are exacerbated by ASA/NSAID exposure and refractory to conventional medical or surgical treatment. Some patients are accompanied by cutaneous symptoms such as urticaria, angioedema, flushing or gastrointestinal symptoms (Buchheit and Laidlaw, 2016). Previous studies suggested that NERD is more common in females (middle-age onset) and non-atopics (Choi et al., 2015; Trinh et al., 2018). It was reported that rhinitis symptoms appear and then evolve into CRS which worsens asthmatic symptoms, subsequently followed by ASA intolerance (Szczeklik et al., 2000). However, their clinical presentations and courses have been found to be heterogeneous. It has been increasingly required to classify the subphenotypes of NERD according to its clinical features. One study demonstrated 4 subphenotypes by applying a latent class analysis in a Polish cohort: class 1 patients showing moderate asthma with upper airway symptoms and blood eosinophilia; class 2 patients showing mild asthma with low healthcare use; class 3 patients showing severe asthma with severe exacerbation and airway obstruction; and class 4 patients showing poorly controlled asthma with frequent and severe exacerbation (Bochenek et al., 2014). Another study showed 4 subtypes presenting distinct clinical/biochemical findings in a Korean cohort using a 2-step cluster analysis based on 3 clinical phenotypes (urticaria, CRS and atopy status): subtype 1 (NERD with CRS/atopy and no urticaria), subtype 2 (NERD with CRS and no urticaria/atopy), subtype 3 (NERD without CRS/urticaria), and subtype 4 (NERD with acute/chronic urticaria exacerbated by NSAID exposure) (Lee et al., 2017). Each subtype had distinct features in the aspect of female proportion, the degree of eosinophilia, leukotriene (LT) E4 metabolite levels, the frequency of asthma exacerbation, medication requirements (high-dose ICS-LABA or systemic corticosteroids) and asthma severity, suggesting that stratified strategies according to subtype classification may help achieve better clinical outcomes in the management of NERD.
USER:
Is it possible to have a reaction to ibuprofen? I've lately started getting flushed and have trouble breathing every time I take it. If it is the ibuprofen what's happening? Is there a test I can take for this? Please explain simply and keep the response to under 500 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 50 | 807 | null | 739 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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Can a President be charged with a crime for his or her actions taken while President? If not, are there any exceptions to a get-out-of-jail-free card?
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A grand jury indicted former President Donald J. Trump on four counts for conduct that occurred during his Presidency following the November 2020 election. The indictment alleged that after losing that election, Trump conspired to overturn it by spreading knowingly false claims of election fraud to obstruct the collecting, counting, and certifying of the election results. Trump moved to dismiss the indictment based on Presidential immunity, arguing that a President has absolute immunity from criminal prosecution for actions performed within the outer perimeter of his official responsibilities, and that the indictment’s allegations fell within the core of his official duties. The District Court denied Trump’s motion to dismiss, holding that former Presidents do not possess federal criminal immunity for any acts. The D. C. Circuit affirmed. Both the District Court and the D. C. Circuit declined to decide whether the indicted conduct involved official acts. Held: Under our constitutional structure of separated powers, the nature of Presidential power entitles a former President to absolute immunity from criminal prosecution for actions within his conclusive and preclusive constitutional authority. And he is entitled to at least presumptive immunity from prosecution for all his official acts. There is no immunity for unofficial acts. Pp. 5–43. (a) This case is the first criminal prosecution in our Nation’s history of a former President for actions taken during his Presidency. Determining whether and under what circumstances such a prosecution may proceed requires careful assessment of the scope of Presidential power under the Constitution. The nature of that power requires that a former President have some immunity from criminal prosecution for official acts during his tenure in office. At least with respect to the President’s exercise of his core constitutional powers, this immunity must be absolute. As for his remaining official actions, he is entitled to at least presumptive immunity. Pp. 5–15 (1) Article II of the Constitution vests “executive Power” in “a President of the United States of America.” §1, cl. 1. The President has duties of “unrivaled gravity and breadth.” Trump v. Vance, 591 U. S. 786, 800. His authority to act necessarily “stem[s] either from an act of Congress or from the Constitution itself.” Youngstown Sheet & Tube Co. v. Sawyer, 343 U. S. 579, 585. In the latter case, the President’s authority is sometimes “conclusive and preclusive.” Id., at 638 (Jackson, J., concurring). When the President exercises such authority, Congress cannot act on, and courts cannot examine, the President’s actions. It follows that an Act of Congress—either a specific one targeted at the President or a generally applicable one—may not criminalize the President’s actions within his exclusive constitutional power. Neither may the courts adjudicate a criminal prosecution that examines such Presidential actions. The Court thus concludes that the President is absolutely immune from criminal prosecution for conduct within his exclusive sphere of constitutional authority. Pp. 6–9. 2) Not all of the President’s official acts fall within his “conclusive and preclusive” authority. The reasons that justify the President’s absolute immunity from criminal prosecution for acts within the scope of his exclusive constitutional authority do not extend to conduct in areas where his authority is shared with Congress. To determine the President’s immunity in this context, the Court looks primarily to the Framers’ design of the Presidency within the separation of powers, precedent on Presidential immunity in the civil context, and criminal cases where a President resisted prosecutorial demands for documents. P. 9. (i) The Framers designed the Presidency to provide for a “vigorous” and “energetic” Executive. The Federalist No. 70, pp. 471–472 (J. Cooke ed. 1961) (A. Hamilton). They vested the President with “supervisory and policy responsibilities of utmost discretion and sensitivity.” Nixon v. Fitzgerald, 457 U. S. 731, 750. Appreciating the “unique risks” that arise when the President’s energies are diverted by proceedings that might render him “unduly cautious in the discharge of his official duties,” the Court has recognized Presidential immunities and privileges “rooted in the constitutional tradition of the separation of powers and supported by our history.” Id., at 749, 751, 752, n. 32. In Fitzgerald, for instance, the Court concluded that a former President is entitled to absolute immunity from “damages liability for acts within the ‘outer perimeter’ of his official responsibility.” Id., at 756. The Court’s “dominant concern” was to avoid “diversion of the President’s attention during the decision-making process caused by needless worry as to the possibility of damages actions stemming from any particular official decision.” Clinton v. Jones, 520 U. S. 681, 694, n. 19.
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"================ <TEXT PASSAGE> ======= A grand jury indicted former President Donald J. Trump on four counts for conduct that occurred during his Presidency following the November 2020 election. The indictment alleged that after losing that election, Trump conspired to overturn it by spreading knowingly false claims of election fraud to obstruct the collecting, counting, and certifying of the election results. Trump moved to dismiss the indictment based on Presidential immunity, arguing that a President has absolute immunity from criminal prosecution for actions performed within the outer perimeter of his official responsibilities, and that the indictment’s allegations fell within the core of his official duties. The District Court denied Trump’s motion to dismiss, holding that former Presidents do not possess federal criminal immunity for any acts. The D. C. Circuit affirmed. Both the District Court and the D. C. Circuit declined to decide whether the indicted conduct involved official acts. Held: Under our constitutional structure of separated powers, the nature of Presidential power entitles a former President to absolute immunity from criminal prosecution for actions within his conclusive and preclusive constitutional authority. And he is entitled to at least presumptive immunity from prosecution for all his official acts. There is no immunity for unofficial acts. Pp. 5–43. (a) This case is the first criminal prosecution in our Nation’s history of a former President for actions taken during his Presidency. Determining whether and under what circumstances such a prosecution may proceed requires careful assessment of the scope of Presidential power under the Constitution. The nature of that power requires that a former President have some immunity from criminal prosecution for official acts during his tenure in office. At least with respect to the President’s exercise of his core constitutional powers, this immunity must be absolute. As for his remaining official actions, he is entitled to at least presumptive immunity. Pp. 5–15 (1) Article II of the Constitution vests “executive Power” in “a President of the United States of America.” §1, cl. 1. The President has duties of “unrivaled gravity and breadth.” Trump v. Vance, 591 U. S. 786, 800. His authority to act necessarily “stem[s] either from an act of Congress or from the Constitution itself.” Youngstown Sheet & Tube Co. v. Sawyer, 343 U. S. 579, 585. In the latter case, the President’s authority is sometimes “conclusive and preclusive.” Id., at 638 (Jackson, J., concurring). When the President exercises such authority, Congress cannot act on, and courts cannot examine, the President’s actions. It follows that an Act of Congress—either a specific one targeted at the President or a generally applicable one—may not criminalize the President’s actions within his exclusive constitutional power. Neither may the courts adjudicate a criminal prosecution that examines such Presidential actions. The Court thus concludes that the President is absolutely immune from criminal prosecution for conduct within his exclusive sphere of constitutional authority. Pp. 6–9. 2) Not all of the President’s official acts fall within his “conclusive and preclusive” authority. The reasons that justify the President’s absolute immunity from criminal prosecution for acts within the scope of his exclusive constitutional authority do not extend to conduct in areas where his authority is shared with Congress. To determine the President’s immunity in this context, the Court looks primarily to the Framers’ design of the Presidency within the separation of powers, precedent on Presidential immunity in the civil context, and criminal cases where a President resisted prosecutorial demands for documents. P. 9. (i) The Framers designed the Presidency to provide for a “vigorous” and “energetic” Executive. The Federalist No. 70, pp. 471–472 (J. Cooke ed. 1961) (A. Hamilton). They vested the President with “supervisory and policy responsibilities of utmost discretion and sensitivity.” Nixon v. Fitzgerald, 457 U. S. 731, 750. Appreciating the “unique risks” that arise when the President’s energies are diverted by proceedings that might render him “unduly cautious in the discharge of his official duties,” the Court has recognized Presidential immunities and privileges “rooted in the constitutional tradition of the separation of powers and supported by our history.” Id., at 749, 751, 752, n. 32. In Fitzgerald, for instance, the Court concluded that a former President is entitled to absolute immunity from “damages liability for acts within the ‘outer perimeter’ of his official responsibility.” Id., at 756. The Court’s “dominant concern” was to avoid “diversion of the President’s attention during the decision-making process caused by needless worry as to the possibility of damages actions stemming from any particular official decision.” Clinton v. Jones, 520 U. S. 681, 694, n. 19. https://www.supremecourt.gov/opinions/23pdf/23-939_e2pg.pdf ================ <QUESTION> ======= Can a President be charged with a crime for his or her actions taken while President? If not, are there any exceptions to a get-out-of-jail-free card? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
A grand jury indicted former President Donald J. Trump on four counts for conduct that occurred during his Presidency following the November 2020 election. The indictment alleged that after losing that election, Trump conspired to overturn it by spreading knowingly false claims of election fraud to obstruct the collecting, counting, and certifying of the election results. Trump moved to dismiss the indictment based on Presidential immunity, arguing that a President has absolute immunity from criminal prosecution for actions performed within the outer perimeter of his official responsibilities, and that the indictment’s allegations fell within the core of his official duties. The District Court denied Trump’s motion to dismiss, holding that former Presidents do not possess federal criminal immunity for any acts. The D. C. Circuit affirmed. Both the District Court and the D. C. Circuit declined to decide whether the indicted conduct involved official acts. Held: Under our constitutional structure of separated powers, the nature of Presidential power entitles a former President to absolute immunity from criminal prosecution for actions within his conclusive and preclusive constitutional authority. And he is entitled to at least presumptive immunity from prosecution for all his official acts. There is no immunity for unofficial acts. Pp. 5–43. (a) This case is the first criminal prosecution in our Nation’s history of a former President for actions taken during his Presidency. Determining whether and under what circumstances such a prosecution may proceed requires careful assessment of the scope of Presidential power under the Constitution. The nature of that power requires that a former President have some immunity from criminal prosecution for official acts during his tenure in office. At least with respect to the President’s exercise of his core constitutional powers, this immunity must be absolute. As for his remaining official actions, he is entitled to at least presumptive immunity. Pp. 5–15 (1) Article II of the Constitution vests “executive Power” in “a President of the United States of America.” §1, cl. 1. The President has duties of “unrivaled gravity and breadth.” Trump v. Vance, 591 U. S. 786, 800. His authority to act necessarily “stem[s] either from an act of Congress or from the Constitution itself.” Youngstown Sheet & Tube Co. v. Sawyer, 343 U. S. 579, 585. In the latter case, the President’s authority is sometimes “conclusive and preclusive.” Id., at 638 (Jackson, J., concurring). When the President exercises such authority, Congress cannot act on, and courts cannot examine, the President’s actions. It follows that an Act of Congress—either a specific one targeted at the President or a generally applicable one—may not criminalize the President’s actions within his exclusive constitutional power. Neither may the courts adjudicate a criminal prosecution that examines such Presidential actions. The Court thus concludes that the President is absolutely immune from criminal prosecution for conduct within his exclusive sphere of constitutional authority. Pp. 6–9. 2) Not all of the President’s official acts fall within his “conclusive and preclusive” authority. The reasons that justify the President’s absolute immunity from criminal prosecution for acts within the scope of his exclusive constitutional authority do not extend to conduct in areas where his authority is shared with Congress. To determine the President’s immunity in this context, the Court looks primarily to the Framers’ design of the Presidency within the separation of powers, precedent on Presidential immunity in the civil context, and criminal cases where a President resisted prosecutorial demands for documents. P. 9. (i) The Framers designed the Presidency to provide for a “vigorous” and “energetic” Executive. The Federalist No. 70, pp. 471–472 (J. Cooke ed. 1961) (A. Hamilton). They vested the President with “supervisory and policy responsibilities of utmost discretion and sensitivity.” Nixon v. Fitzgerald, 457 U. S. 731, 750. Appreciating the “unique risks” that arise when the President’s energies are diverted by proceedings that might render him “unduly cautious in the discharge of his official duties,” the Court has recognized Presidential immunities and privileges “rooted in the constitutional tradition of the separation of powers and supported by our history.” Id., at 749, 751, 752, n. 32. In Fitzgerald, for instance, the Court concluded that a former President is entitled to absolute immunity from “damages liability for acts within the ‘outer perimeter’ of his official responsibility.” Id., at 756. The Court’s “dominant concern” was to avoid “diversion of the President’s attention during the decision-making process caused by needless worry as to the possibility of damages actions stemming from any particular official decision.” Clinton v. Jones, 520 U. S. 681, 694, n. 19.
USER:
Can a President be charged with a crime for his or her actions taken while President? If not, are there any exceptions to a get-out-of-jail-free card?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 26 | 748 | null | 33 |
Do not use any information besides what is provided within the prompt. Do not use any prior knowledge or outside sources. Answer with section headings and bullet points.
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Summarize each cosmetic regulation pre- and post-MoCRA.
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Premarket Requirements Unlike its authority over drugs and some devices, FDA does not have the authority, either pre- or post-MoCRA, to require premarket approval of cosmetics or their ingredients, except for color additives.61 Prior to MoCRA, it was FDA’s position that manufacturers were responsible for substantiating the safety of their products and ingredients before the products were marketed.62 With the passage of MoCRA, manufacturers are now statutorily required to substantiate the safety of their products. MoCRA also expands upon required recordkeeping by manufacturers, packers, and distributors. A “responsible person”63 for a cosmetic product must ensure that it has been adequately tested to substantiate safety,64 and that records supporting this substantiation are maintained by the same responsible person.65 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s safety substantiation and recordkeeping requirements.66 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.67 Enforcement Among various enforcement mechanisms, under MoCRA, FDA may access and copy all records related to a cosmetic product that it reasonably believes is likely adulterated and a serious danger Modernization of Cosmetics Regulation Act of 2022 (MoCRA) Congressional Research Service 9 to humans. FDA may access and copy all records necessary to determine whether a cosmetic or related product is adulterated and a serious threat to human health, barring certain cosmetic formula, personnel, research, and financial data records. Accessible records include those related to safety substantiation data for cosmetic products and their ingredients.68 Registration and Listing Prior to MoCRA, cosmetic manufacturers were not required to register their establishments or list their products with FDA. Instead, according to FDA regulations, owners or operators of establishments that manufactured or packaged cosmetics were requested to register with FDA.69 Likewise, previous to MoCRA, manufacturers, packers, and distributors of cosmetic products were requested to file a cosmetic product ingredient statement (CPIS) containing certain information on each cosmetic product they marketed.70 Entities could submit registration information and CPISs to FDA’s Voluntary Cosmetic Registration Program (VCRP).71 Under MoCRA, both facility72 registration and product listings are now required.73 Existing and new facilities that manufacture or process cosmetic products for distribution in the United States must be registered with FDA. These registrations must be renewed every two years and updated within 60 days of a content revision.74 Domestic facilities registering with FDA must provide the facility’s name, physical address, email address, and phone number, while foreign facilities must provide contact information for an agent within the United States and, if available, electronic contact information. Additionally, a facility must include its registration number, if one was previously assigned, and all brand names associated with cosmetic products sold that were manufactured or processed at that facility. The product categories and responsible person for each cosmetic product manufactured or processed at the facility must also be provided.75 Each responsible person must also ensure the submission of a cosmetic product listing with FDA that is renewed and updated annually.76 The product listing must contain the manufacturing or processing facility’s registration number, the responsible person’s name and contact number, the name of the cosmetic product as it appears on the label, the categories the cosmetic product falls under, and the product’s listing number. Additionally, the product listing must include a list of the cosmetic product’s ingredients, “including any fragrances, flavors, or colors, with each ingredient identified by name.”77 FDA will assign private product and facility identification numbers upon initial listing submission or registration.78 With the advent of MoCRA, FDA reported the VCRP had been discontinued and was no longer accepting submissions. In a draft guidance released in August 2023, FDA stated it is developing a new electronic submission portal for registration and listing information.79 FDA noted that this new portal is expected to be available by October 2023.80 In the interim, FDA requests that no registration or listing information be sent to the agency, adding that information previously listed in the VCRP will not be transferred.81 In September 2023, FDA released for comment draft versions of the prospective electronic submission portal, Cosmetics Direct, and paper forms.82 MoCRA exempts certain small businesses83 from both facility registration and product listing requirements.84 However, a small business is not exempt from these requirements if it is engaged in the manufacturing or processing of higher-risk cosmetic products that “regularly come into contact with [the] mucus membrane of the eye under conditions of use that are customary or usual,” “[c]osmetic products that are injected” (see the text box below), “intended for internal use,” or that are meant to “alter [one’s] appearance for more than 24 hours under conditions of use that are customary or usual and removal by the consumer is not part of such conditions of use that are customary or usual.”85 Additionally, certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from facility registration and product listing requirements.86 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply.87 Enforcement Under MoCRA, if FDA determines that a cosmetic product has a reasonable probability of causing serious harm to human health, and if FDA has a reasonable belief that other products manufactured or processed at the same facility may be similarly affected, FDA may suspend the registration of the facility connected with such products.88 If a facility’s registration is suspended, any cosmetic product from that facility is barred from introduction or delivery for introduction into U.S. commerce.89 Before suspending a facility’s registration, the FDA must provide notice to a responsible person for the facility specifying the reason for suspension, as well as an opportunity, within five business days of the notice, to present a plan to correct the issue identified.90 FDA must provide the responsible person with the opportunity for an informal hearing to review actions required for registration reinstatement and why the facility registration should be reinstated.91 If, based upon the evidence presented at this informal hearing, FDA determines there are inadequate grounds to continue the suspension, the facility registration will be restored.92 However, if there is insufficient evidence presented, the suspension may continue, and FDA shall require the responsible person to submit a corrective action plan for review.93 If at any point FDA determines there is inadequate evidence to justify the continued suspension of a facility’s registration, the registration shall be promptly reinstated.94 Mandatory Recall Prior to MoCRA, FDA did not have the authority to order mandatory recalls of cosmetic products. The agency could, however, request a company to voluntarily recall cosmetic products of concern.114 Under MoCRA, a responsible person may still have the opportunity to voluntarily recall an adulterated or misbranded cosmetic; however, now FDA also has the authority to issue a mandatory recall.115 A mandatory recall may be initiated “[i]f the Secretary determines that there is a reasonable probability that a cosmetic is adulterated … or misbranded … and the use of or exposure to such cosmetic will cause serious adverse health consequences or death,” and the responsible person refuses to comply with a voluntary recall in a timely manner. Upon FDA issuing an order for a mandatory recall, the responsible person must immediately stop distributing the identified product.116 If such an order is issued, the responsible person is entitled to an opportunity for a timely informal hearing to review the adequacy of evidence for the order.117 Depending on the outcome of this review, the order may be vacated, continued until a specified date, or amended to further require the recall of the cosmetic product, along with other measures regarding notifications, timetables, and updates.118 FDA may require the responsible person to issue a notice of recall or ceased distribution to appropriate persons, including manufacturers, distributors, importers, and sellers.119 If a product is recalled, FDA must ensure that a press release announcing the action is published, as well as appropriate alerts and public notices, to provide consumers and retailers with information about the cosmetic product and the circumstances of the recall. If an image of the product is available and appropriate, FDA shall also ensure the publication of that image on its website.120 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s mandatory recall authority.121 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.122
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Summarize each cosmetic regulation pre- and post-MoCRA. Do not use any information besides what is provided within the prompt. Do not use any prior knowledge or outside sources. Answer with section headings and bullet points. Premarket Requirements Unlike its authority over drugs and some devices, FDA does not have the authority, either pre- or post-MoCRA, to require premarket approval of cosmetics or their ingredients, except for color additives.61 Prior to MoCRA, it was FDA’s position that manufacturers were responsible for substantiating the safety of their products and ingredients before the products were marketed.62 With the passage of MoCRA, manufacturers are now statutorily required to substantiate the safety of their products. MoCRA also expands upon required recordkeeping by manufacturers, packers, and distributors. A “responsible person”63 for a cosmetic product must ensure that it has been adequately tested to substantiate safety,64 and that records supporting this substantiation are maintained by the same responsible person.65 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s safety substantiation and recordkeeping requirements.66 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.67 Enforcement Among various enforcement mechanisms, under MoCRA, FDA may access and copy all records related to a cosmetic product that it reasonably believes is likely adulterated and a serious danger Modernization of Cosmetics Regulation Act of 2022 (MoCRA) Congressional Research Service 9 to humans. FDA may access and copy all records necessary to determine whether a cosmetic or related product is adulterated and a serious threat to human health, barring certain cosmetic formula, personnel, research, and financial data records. Accessible records include those related to safety substantiation data for cosmetic products and their ingredients.68 Registration and Listing Prior to MoCRA, cosmetic manufacturers were not required to register their establishments or list their products with FDA. Instead, according to FDA regulations, owners or operators of establishments that manufactured or packaged cosmetics were requested to register with FDA.69 Likewise, previous to MoCRA, manufacturers, packers, and distributors of cosmetic products were requested to file a cosmetic product ingredient statement (CPIS) containing certain information on each cosmetic product they marketed.70 Entities could submit registration information and CPISs to FDA’s Voluntary Cosmetic Registration Program (VCRP).71 Under MoCRA, both facility72 registration and product listings are now required.73 Existing and new facilities that manufacture or process cosmetic products for distribution in the United States must be registered with FDA. These registrations must be renewed every two years and updated within 60 days of a content revision.74 Domestic facilities registering with FDA must provide the facility’s name, physical address, email address, and phone number, while foreign facilities must provide contact information for an agent within the United States and, if available, electronic contact information. Additionally, a facility must include its registration number, if one was previously assigned, and all brand names associated with cosmetic products sold that were manufactured or processed at that facility. The product categories and responsible person for each cosmetic product manufactured or processed at the facility must also be provided.75 Each responsible person must also ensure the submission of a cosmetic product listing with FDA that is renewed and updated annually.76 The product listing must contain the manufacturing or processing facility’s registration number, the responsible person’s name and contact number, the name of the cosmetic product as it appears on the label, the categories the cosmetic product falls under, and the product’s listing number. Additionally, the product listing must include a list of the cosmetic product’s ingredients, “including any fragrances, flavors, or colors, with each ingredient identified by name.”77 FDA will assign private product and facility identification numbers upon initial listing submission or registration.78 With the advent of MoCRA, FDA reported the VCRP had been discontinued and was no longer accepting submissions. In a draft guidance released in August 2023, FDA stated it is developing a new electronic submission portal for registration and listing information.79 FDA noted that this new portal is expected to be available by October 2023.80 In the interim, FDA requests that no registration or listing information be sent to the agency, adding that information previously listed in the VCRP will not be transferred.81 In September 2023, FDA released for comment draft versions of the prospective electronic submission portal, Cosmetics Direct, and paper forms.82 MoCRA exempts certain small businesses83 from both facility registration and product listing requirements.84 However, a small business is not exempt from these requirements if it is engaged in the manufacturing or processing of higher-risk cosmetic products that “regularly come into contact with [the] mucus membrane of the eye under conditions of use that are customary or usual,” “[c]osmetic products that are injected” (see the text box below), “intended for internal use,” or that are meant to “alter [one’s] appearance for more than 24 hours under conditions of use that are customary or usual and removal by the consumer is not part of such conditions of use that are customary or usual.”85 Additionally, certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from facility registration and product listing requirements.86 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply.87 Enforcement Under MoCRA, if FDA determines that a cosmetic product has a reasonable probability of causing serious harm to human health, and if FDA has a reasonable belief that other products manufactured or processed at the same facility may be similarly affected, FDA may suspend the registration of the facility connected with such products.88 If a facility’s registration is suspended, any cosmetic product from that facility is barred from introduction or delivery for introduction into U.S. commerce.89 Before suspending a facility’s registration, the FDA must provide notice to a responsible person for the facility specifying the reason for suspension, as well as an opportunity, within five business days of the notice, to present a plan to correct the issue identified.90 FDA must provide the responsible person with the opportunity for an informal hearing to review actions required for registration reinstatement and why the facility registration should be reinstated.91 If, based upon the evidence presented at this informal hearing, FDA determines there are inadequate grounds to continue the suspension, the facility registration will be restored.92 However, if there is insufficient evidence presented, the suspension may continue, and FDA shall require the responsible person to submit a corrective action plan for review.93 If at any point FDA determines there is inadequate evidence to justify the continued suspension of a facility’s registration, the registration shall be promptly reinstated.94 Mandatory Recall Prior to MoCRA, FDA did not have the authority to order mandatory recalls of cosmetic products. The agency could, however, request a company to voluntarily recall cosmetic products of concern.114 Under MoCRA, a responsible person may still have the opportunity to voluntarily recall an adulterated or misbranded cosmetic; however, now FDA also has the authority to issue a mandatory recall.115 A mandatory recall may be initiated “[i]f the Secretary determines that there is a reasonable probability that a cosmetic is adulterated … or misbranded … and the use of or exposure to such cosmetic will cause serious adverse health consequences or death,” and the responsible person refuses to comply with a voluntary recall in a timely manner. Upon FDA issuing an order for a mandatory recall, the responsible person must immediately stop distributing the identified product.116 If such an order is issued, the responsible person is entitled to an opportunity for a timely informal hearing to review the adequacy of evidence for the order.117 Depending on the outcome of this review, the order may be vacated, continued until a specified date, or amended to further require the recall of the cosmetic product, along with other measures regarding notifications, timetables, and updates.118 FDA may require the responsible person to issue a notice of recall or ceased distribution to appropriate persons, including manufacturers, distributors, importers, and sellers.119 If a product is recalled, FDA must ensure that a press release announcing the action is published, as well as appropriate alerts and public notices, to provide consumers and retailers with information about the cosmetic product and the circumstances of the recall. If an image of the product is available and appropriate, FDA shall also ensure the publication of that image on its website.120 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s mandatory recall authority.121 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.122
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Do not use any information besides what is provided within the prompt. Do not use any prior knowledge or outside sources. Answer with section headings and bullet points.
EVIDENCE:
Premarket Requirements Unlike its authority over drugs and some devices, FDA does not have the authority, either pre- or post-MoCRA, to require premarket approval of cosmetics or their ingredients, except for color additives.61 Prior to MoCRA, it was FDA’s position that manufacturers were responsible for substantiating the safety of their products and ingredients before the products were marketed.62 With the passage of MoCRA, manufacturers are now statutorily required to substantiate the safety of their products. MoCRA also expands upon required recordkeeping by manufacturers, packers, and distributors. A “responsible person”63 for a cosmetic product must ensure that it has been adequately tested to substantiate safety,64 and that records supporting this substantiation are maintained by the same responsible person.65 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s safety substantiation and recordkeeping requirements.66 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.67 Enforcement Among various enforcement mechanisms, under MoCRA, FDA may access and copy all records related to a cosmetic product that it reasonably believes is likely adulterated and a serious danger Modernization of Cosmetics Regulation Act of 2022 (MoCRA) Congressional Research Service 9 to humans. FDA may access and copy all records necessary to determine whether a cosmetic or related product is adulterated and a serious threat to human health, barring certain cosmetic formula, personnel, research, and financial data records. Accessible records include those related to safety substantiation data for cosmetic products and their ingredients.68 Registration and Listing Prior to MoCRA, cosmetic manufacturers were not required to register their establishments or list their products with FDA. Instead, according to FDA regulations, owners or operators of establishments that manufactured or packaged cosmetics were requested to register with FDA.69 Likewise, previous to MoCRA, manufacturers, packers, and distributors of cosmetic products were requested to file a cosmetic product ingredient statement (CPIS) containing certain information on each cosmetic product they marketed.70 Entities could submit registration information and CPISs to FDA’s Voluntary Cosmetic Registration Program (VCRP).71 Under MoCRA, both facility72 registration and product listings are now required.73 Existing and new facilities that manufacture or process cosmetic products for distribution in the United States must be registered with FDA. These registrations must be renewed every two years and updated within 60 days of a content revision.74 Domestic facilities registering with FDA must provide the facility’s name, physical address, email address, and phone number, while foreign facilities must provide contact information for an agent within the United States and, if available, electronic contact information. Additionally, a facility must include its registration number, if one was previously assigned, and all brand names associated with cosmetic products sold that were manufactured or processed at that facility. The product categories and responsible person for each cosmetic product manufactured or processed at the facility must also be provided.75 Each responsible person must also ensure the submission of a cosmetic product listing with FDA that is renewed and updated annually.76 The product listing must contain the manufacturing or processing facility’s registration number, the responsible person’s name and contact number, the name of the cosmetic product as it appears on the label, the categories the cosmetic product falls under, and the product’s listing number. Additionally, the product listing must include a list of the cosmetic product’s ingredients, “including any fragrances, flavors, or colors, with each ingredient identified by name.”77 FDA will assign private product and facility identification numbers upon initial listing submission or registration.78 With the advent of MoCRA, FDA reported the VCRP had been discontinued and was no longer accepting submissions. In a draft guidance released in August 2023, FDA stated it is developing a new electronic submission portal for registration and listing information.79 FDA noted that this new portal is expected to be available by October 2023.80 In the interim, FDA requests that no registration or listing information be sent to the agency, adding that information previously listed in the VCRP will not be transferred.81 In September 2023, FDA released for comment draft versions of the prospective electronic submission portal, Cosmetics Direct, and paper forms.82 MoCRA exempts certain small businesses83 from both facility registration and product listing requirements.84 However, a small business is not exempt from these requirements if it is engaged in the manufacturing or processing of higher-risk cosmetic products that “regularly come into contact with [the] mucus membrane of the eye under conditions of use that are customary or usual,” “[c]osmetic products that are injected” (see the text box below), “intended for internal use,” or that are meant to “alter [one’s] appearance for more than 24 hours under conditions of use that are customary or usual and removal by the consumer is not part of such conditions of use that are customary or usual.”85 Additionally, certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from facility registration and product listing requirements.86 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply.87 Enforcement Under MoCRA, if FDA determines that a cosmetic product has a reasonable probability of causing serious harm to human health, and if FDA has a reasonable belief that other products manufactured or processed at the same facility may be similarly affected, FDA may suspend the registration of the facility connected with such products.88 If a facility’s registration is suspended, any cosmetic product from that facility is barred from introduction or delivery for introduction into U.S. commerce.89 Before suspending a facility’s registration, the FDA must provide notice to a responsible person for the facility specifying the reason for suspension, as well as an opportunity, within five business days of the notice, to present a plan to correct the issue identified.90 FDA must provide the responsible person with the opportunity for an informal hearing to review actions required for registration reinstatement and why the facility registration should be reinstated.91 If, based upon the evidence presented at this informal hearing, FDA determines there are inadequate grounds to continue the suspension, the facility registration will be restored.92 However, if there is insufficient evidence presented, the suspension may continue, and FDA shall require the responsible person to submit a corrective action plan for review.93 If at any point FDA determines there is inadequate evidence to justify the continued suspension of a facility’s registration, the registration shall be promptly reinstated.94 Mandatory Recall Prior to MoCRA, FDA did not have the authority to order mandatory recalls of cosmetic products. The agency could, however, request a company to voluntarily recall cosmetic products of concern.114 Under MoCRA, a responsible person may still have the opportunity to voluntarily recall an adulterated or misbranded cosmetic; however, now FDA also has the authority to issue a mandatory recall.115 A mandatory recall may be initiated “[i]f the Secretary determines that there is a reasonable probability that a cosmetic is adulterated … or misbranded … and the use of or exposure to such cosmetic will cause serious adverse health consequences or death,” and the responsible person refuses to comply with a voluntary recall in a timely manner. Upon FDA issuing an order for a mandatory recall, the responsible person must immediately stop distributing the identified product.116 If such an order is issued, the responsible person is entitled to an opportunity for a timely informal hearing to review the adequacy of evidence for the order.117 Depending on the outcome of this review, the order may be vacated, continued until a specified date, or amended to further require the recall of the cosmetic product, along with other measures regarding notifications, timetables, and updates.118 FDA may require the responsible person to issue a notice of recall or ceased distribution to appropriate persons, including manufacturers, distributors, importers, and sellers.119 If a product is recalled, FDA must ensure that a press release announcing the action is published, as well as appropriate alerts and public notices, to provide consumers and retailers with information about the cosmetic product and the circumstances of the recall. If an image of the product is available and appropriate, FDA shall also ensure the publication of that image on its website.120 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s mandatory recall authority.121 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.122
USER:
Summarize each cosmetic regulation pre- and post-MoCRA.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 7 | 1,417 | null | 194 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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Give an overview of the MBTI test and explain its connection to Jungian psychology. What are the possible applications of the MBTI in the areas of psychiatry and patient-doctor communications, and what are the best ways to implement this? What are the implied limitations of using the MBTI in a clinical setting?
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The Myers-Briggs type indicator (MBTI) is a measure of personality type based on the work of psychologist Carl Jung. Isabel Myers developed the MBTI during the Second World War to facilitate better working relationships between healthcare professionals, particularly nurses.[1] She modeled this questionnaire on Jung's theory of "individual preference," which suggests that seemingly random variation in human behavior is attributable to fundamental individual differences in mental and emotional functioning.[2] Myers described these variations as simply different ways individuals prefer to use their minds. The indicator operationalizes these preferences with questions indicating the individual's propensity towards 1 end of a dipole in 4 categories: Energy Perceiving Judging Orientation Energy Energy encompasses the scale of extraversion to introversion. Those tending towards extraversion direct their attention to external experiences and actions, deriving energy from those around them. Those tending towards introversion direct their attention towards inner thoughts and ideas, acquiring energy from solitude. Perceiving Perceiving describes how individuals prefer to intake information on the sensing scale versus intuitive types. Sensing types prefer to gather information using the 5 senses. They require gathering facts before understanding general ideas and patterns. Intuitive types prefer to rely on instincts and view problems from the "big picture" perspective, realizing general patterns before identifying constituent facts. Judging Judging categorizes how individuals prefer to make decisions from thinking to feeling. Thinkers rely on logic and facts, while feelers seek harmony in resolving an issue. Orientation Orientation applies to the preferred lifestyle on the scale of judging to perceiving. Those preferring judgment tend towards an orderly, decisive, and settled lifestyle, while those who prefer a more flexible, unpredictable existence align with the perceiving type.[1] Sixteen personality types are possible with the combinations of 2 poles in 4 different categories. The representation of these types is with 4 letters indicating the individual's propensity in each category. For example, someone tending towards extraversion in energy, intuition in perceiving, thinking in judging, and perceiving in orientation would have the personality type ENTP. The goal of the Myers-Briggs typology is to increase awareness of oneself and others and advance through Jung's "individuation." This process is describable as the integration, differentiation, and development of one's traits and skills.[2] One can begin analyzing and applying those preferences in work and personal endeavors by understanding one's individual preferences. Issues of Concern Myer's primary intended application of the MBTI was for team building in the healthcare setting. Differences in approach to problem-solving and communication have the potential to create barriers to teamwork. Understanding these different thinking and perceiving preferences through MBTI typology can inform strategic changes to workflow and evaluation techniques.[3] Clinical Significance Although the MBTI was not designed for clinical use, it has had application to some patient populations. In psychology and psychiatry, the MBTI may help understand specific patient populations, such as those suffering from suicidality and unipolar depression. In both populations, greater tendencies towards introversion energy and perception orientation have been identified compared to the normative population. The researchers suggest that with more confirmatory samples, these correlations may be useful in identifying vulnerability in patients with affective disorder.[4][5] Most significantly, the MBTI may have applications to fostering communication between healthcare professionals and patients. It is important to consider possible communication differences between the provider and the patient. For example, some research suggests that there are significantly more introverts, intuitive perceivers, thinking deciders, and judging-oriented individuals among a doctor population compared to a general adult population, which consists of more extroverts, sensing-perceivers, feeling deciders, and perceiving-orientated persons.[6] These potential differences can affect patients' interpretations of their provider encounters. A doctor tending towards intuitive perception and thinking judgment may be inclined to approach communication with the following attitudes: Respect my intelligence and desire to understand Demonstrate your competence Answer my questions honestly Give me options to see a pattern [6] However, a patient tending towards sensing, perceiving, and feeling decisions may approach communication with the following attitudes: Listen carefully to me Give me your complete attention Be warm and friendly Give me facts with a personal touch Provide practical information about my condition [6] Suggested approaches to remedy these differences include applying the MBTI typology in communication skills training for health care professionals.[6][7] Formal and structured approaches to instructing professionalism and communication have demonstrated greater effectiveness than passive observational learning, which is critical as improved patient-physician communication correlates better health outcomes as welanded legal action.[8][9][10] Nursing, Allied Health, and Interprofessional Team Interventions All members of the interprofessional healthcare team would do well to have at least a general understanding of the MBTI grading system, as it can facilitate patient interactions, increase empathy for how a patient views their life and world, facilitate interprofessional team communication and collaboration, and lead to improved communication with patients., leading to improved patient outcomes.
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"================ <TEXT PASSAGE> ======= The Myers-Briggs type indicator (MBTI) is a measure of personality type based on the work of psychologist Carl Jung. Isabel Myers developed the MBTI during the Second World War to facilitate better working relationships between healthcare professionals, particularly nurses.[1] She modeled this questionnaire on Jung's theory of "individual preference," which suggests that seemingly random variation in human behavior is attributable to fundamental individual differences in mental and emotional functioning.[2] Myers described these variations as simply different ways individuals prefer to use their minds. The indicator operationalizes these preferences with questions indicating the individual's propensity towards 1 end of a dipole in 4 categories: Energy Perceiving Judging Orientation Energy Energy encompasses the scale of extraversion to introversion. Those tending towards extraversion direct their attention to external experiences and actions, deriving energy from those around them. Those tending towards introversion direct their attention towards inner thoughts and ideas, acquiring energy from solitude. Perceiving Perceiving describes how individuals prefer to intake information on the sensing scale versus intuitive types. Sensing types prefer to gather information using the 5 senses. They require gathering facts before understanding general ideas and patterns. Intuitive types prefer to rely on instincts and view problems from the "big picture" perspective, realizing general patterns before identifying constituent facts. Judging Judging categorizes how individuals prefer to make decisions from thinking to feeling. Thinkers rely on logic and facts, while feelers seek harmony in resolving an issue. Orientation Orientation applies to the preferred lifestyle on the scale of judging to perceiving. Those preferring judgment tend towards an orderly, decisive, and settled lifestyle, while those who prefer a more flexible, unpredictable existence align with the perceiving type.[1] Sixteen personality types are possible with the combinations of 2 poles in 4 different categories. The representation of these types is with 4 letters indicating the individual's propensity in each category. For example, someone tending towards extraversion in energy, intuition in perceiving, thinking in judging, and perceiving in orientation would have the personality type ENTP. The goal of the Myers-Briggs typology is to increase awareness of oneself and others and advance through Jung's "individuation." This process is describable as the integration, differentiation, and development of one's traits and skills.[2] One can begin analyzing and applying those preferences in work and personal endeavors by understanding one's individual preferences. Issues of Concern Myer's primary intended application of the MBTI was for team building in the healthcare setting. Differences in approach to problem-solving and communication have the potential to create barriers to teamwork. Understanding these different thinking and perceiving preferences through MBTI typology can inform strategic changes to workflow and evaluation techniques.[3] Clinical Significance Although the MBTI was not designed for clinical use, it has had application to some patient populations. In psychology and psychiatry, the MBTI may help understand specific patient populations, such as those suffering from suicidality and unipolar depression. In both populations, greater tendencies towards introversion energy and perception orientation have been identified compared to the normative population. The researchers suggest that with more confirmatory samples, these correlations may be useful in identifying vulnerability in patients with affective disorder.[4][5] Most significantly, the MBTI may have applications to fostering communication between healthcare professionals and patients. It is important to consider possible communication differences between the provider and the patient. For example, some research suggests that there are significantly more introverts, intuitive perceivers, thinking deciders, and judging-oriented individuals among a doctor population compared to a general adult population, which consists of more extroverts, sensing-perceivers, feeling deciders, and perceiving-orientated persons.[6] These potential differences can affect patients' interpretations of their provider encounters. A doctor tending towards intuitive perception and thinking judgment may be inclined to approach communication with the following attitudes: Respect my intelligence and desire to understand Demonstrate your competence Answer my questions honestly Give me options to see a pattern [6] However, a patient tending towards sensing, perceiving, and feeling decisions may approach communication with the following attitudes: Listen carefully to me Give me your complete attention Be warm and friendly Give me facts with a personal touch Provide practical information about my condition [6] Suggested approaches to remedy these differences include applying the MBTI typology in communication skills training for health care professionals.[6][7] Formal and structured approaches to instructing professionalism and communication have demonstrated greater effectiveness than passive observational learning, which is critical as improved patient-physician communication correlates better health outcomes as welanded legal action.[8][9][10] Nursing, Allied Health, and Interprofessional Team Interventions All members of the interprofessional healthcare team would do well to have at least a general understanding of the MBTI grading system, as it can facilitate patient interactions, increase empathy for how a patient views their life and world, facilitate interprofessional team communication and collaboration, and lead to improved communication with patients., leading to improved patient outcomes. https://www.ncbi.nlm.nih.gov/books/NBK554596/ ================ <QUESTION> ======= Give an overview of the MBTI test and explain its connection to Jungian psychology. What are the possible applications of the MBTI in the areas of psychiatry and patient-doctor communications, and what are the best ways to implement this? What are the implied limitations of using the MBTI in a clinical setting? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
The Myers-Briggs type indicator (MBTI) is a measure of personality type based on the work of psychologist Carl Jung. Isabel Myers developed the MBTI during the Second World War to facilitate better working relationships between healthcare professionals, particularly nurses.[1] She modeled this questionnaire on Jung's theory of "individual preference," which suggests that seemingly random variation in human behavior is attributable to fundamental individual differences in mental and emotional functioning.[2] Myers described these variations as simply different ways individuals prefer to use their minds. The indicator operationalizes these preferences with questions indicating the individual's propensity towards 1 end of a dipole in 4 categories: Energy Perceiving Judging Orientation Energy Energy encompasses the scale of extraversion to introversion. Those tending towards extraversion direct their attention to external experiences and actions, deriving energy from those around them. Those tending towards introversion direct their attention towards inner thoughts and ideas, acquiring energy from solitude. Perceiving Perceiving describes how individuals prefer to intake information on the sensing scale versus intuitive types. Sensing types prefer to gather information using the 5 senses. They require gathering facts before understanding general ideas and patterns. Intuitive types prefer to rely on instincts and view problems from the "big picture" perspective, realizing general patterns before identifying constituent facts. Judging Judging categorizes how individuals prefer to make decisions from thinking to feeling. Thinkers rely on logic and facts, while feelers seek harmony in resolving an issue. Orientation Orientation applies to the preferred lifestyle on the scale of judging to perceiving. Those preferring judgment tend towards an orderly, decisive, and settled lifestyle, while those who prefer a more flexible, unpredictable existence align with the perceiving type.[1] Sixteen personality types are possible with the combinations of 2 poles in 4 different categories. The representation of these types is with 4 letters indicating the individual's propensity in each category. For example, someone tending towards extraversion in energy, intuition in perceiving, thinking in judging, and perceiving in orientation would have the personality type ENTP. The goal of the Myers-Briggs typology is to increase awareness of oneself and others and advance through Jung's "individuation." This process is describable as the integration, differentiation, and development of one's traits and skills.[2] One can begin analyzing and applying those preferences in work and personal endeavors by understanding one's individual preferences. Issues of Concern Myer's primary intended application of the MBTI was for team building in the healthcare setting. Differences in approach to problem-solving and communication have the potential to create barriers to teamwork. Understanding these different thinking and perceiving preferences through MBTI typology can inform strategic changes to workflow and evaluation techniques.[3] Clinical Significance Although the MBTI was not designed for clinical use, it has had application to some patient populations. In psychology and psychiatry, the MBTI may help understand specific patient populations, such as those suffering from suicidality and unipolar depression. In both populations, greater tendencies towards introversion energy and perception orientation have been identified compared to the normative population. The researchers suggest that with more confirmatory samples, these correlations may be useful in identifying vulnerability in patients with affective disorder.[4][5] Most significantly, the MBTI may have applications to fostering communication between healthcare professionals and patients. It is important to consider possible communication differences between the provider and the patient. For example, some research suggests that there are significantly more introverts, intuitive perceivers, thinking deciders, and judging-oriented individuals among a doctor population compared to a general adult population, which consists of more extroverts, sensing-perceivers, feeling deciders, and perceiving-orientated persons.[6] These potential differences can affect patients' interpretations of their provider encounters. A doctor tending towards intuitive perception and thinking judgment may be inclined to approach communication with the following attitudes: Respect my intelligence and desire to understand Demonstrate your competence Answer my questions honestly Give me options to see a pattern [6] However, a patient tending towards sensing, perceiving, and feeling decisions may approach communication with the following attitudes: Listen carefully to me Give me your complete attention Be warm and friendly Give me facts with a personal touch Provide practical information about my condition [6] Suggested approaches to remedy these differences include applying the MBTI typology in communication skills training for health care professionals.[6][7] Formal and structured approaches to instructing professionalism and communication have demonstrated greater effectiveness than passive observational learning, which is critical as improved patient-physician communication correlates better health outcomes as welanded legal action.[8][9][10] Nursing, Allied Health, and Interprofessional Team Interventions All members of the interprofessional healthcare team would do well to have at least a general understanding of the MBTI grading system, as it can facilitate patient interactions, increase empathy for how a patient views their life and world, facilitate interprofessional team communication and collaboration, and lead to improved communication with patients., leading to improved patient outcomes.
USER:
Give an overview of the MBTI test and explain its connection to Jungian psychology. What are the possible applications of the MBTI in the areas of psychiatry and patient-doctor communications, and what are the best ways to implement this? What are the implied limitations of using the MBTI in a clinical setting?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 52 | 792 | null | 796 |
If you cannot answer the question using the given text, respond with "The text does not contain what you are looking for."
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Using only the provided text, Is Sickle Cell Disease hereditary?
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**What is Sickle Cell Disease?** Sickle cell disease (SCD) is a group of inherited red blood cell disorders. Red blood cells contain hemoglobin, a protein that carries oxygen. Healthy red blood cells are round, and they move through small blood vessels to carry oxygen to all parts of the body. In someone who has SCD, the hemoglobin is abnormal, which causes the red blood cells to become hard and sticky and look like a C-shaped farm tool called a “sickle.” The sickle cells die early, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, they get stuck and clog the blood flow. This can cause pain and other serious complications (health problems) such as infection, acute chest syndrome and stroke. Types of SCD There are several types of SCD. The specific type of SCD a person has depends on the genes they inherited from their parents. People with SCD inherit genes that contain instructions, or code, for abnormal hemoglobin. Below are the most common types of SCD: HbSS People who have this form of SCD inherit two genes, one from each parent, that code for hemoglobin “S.” Hemoglobin S is an abnormal form of hemoglobin that causes the red cells to become rigid, and sickle shaped. This is commonly called sickle cell anemia and is usually the most severe form of the disease. HbSC People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for a different type of abnormal hemoglobin called “C” from the other parent. This is usually a milder form of SCD. Infographic: 5 Facts You Should Know About Sickle Cell Disease Infographic: 5 Facts You Should Know About Sickle Cell Disease Did you know SCD affects people from many parts of the world? HbS beta thalassemia People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for beta thalassemia, another type of hemoglobin abnormality, from the other parent. There are two types of beta thalassemia: “zero” (HbS beta0) and “plus” (HbS beta+). Those with HbS beta0-thalassemia usually have a severe form of SCD. People with HbS beta+-thalassemia tend to have a milder form of SCD. There also are a few rare types of SCD, such as the following: HbSD, HbSE, and HbSO People who have these forms of SCD inherit one hemoglobin “S” gene and one gene that codes for another abnormal type of hemoglobin (“D”, “E”, or “O”). The severity of these rarer types of SCD varies. Sickle Cell Trait (SCT) HbAS People who have sickle cell trait (SCT) inherit a hemoglobin “S” gene from one parent and a normal gene (one that codes for hemoglobin “A”) from the other parent. People with SCT usually do not have any of the signs of the disease. However, in rare cases, a person with SCT may develop health problems; this occurs most often when there are other stresses on the body, such as when a person becomes dehydrated or exercises strenuously. Additionally, people who have SCT can pass the abnormal hemoglobin “S” gene on to their children. Cause of SCD SCD is a genetic condition that is present at birth. It is inherited when a child receives two genes—one from each parent—that code for abnormal hemoglobin. Diagnosis SCD is diagnosed with a simple blood test. In children born in the United States, it most often is found at birth during routine newborn screening tests at the hospital. In addition, SCD can be diagnosed while the baby is in the womb. Diagnostic tests before the baby is born, such as chorionic villus sampling and amniocentesis, can check for chromosomal or genetic abnormalities in the baby. Chorionic villus sampling tests a tiny piece of the placenta, called chorionic villus. Amniocentesis tests a small sample of amniotic fluid surrounding the baby. Because children with SCD are at an increased risk of infection and other health problems, early diagnosis and treatment are important. Complications People with SCD may start to have signs of the disease during the first year of life, usually around 5 months of age. Symptoms and complications of SCD are different for each person and can range from mild to severe. Learn about the complications. Prevention and Treatment of SCD Complications General Prevention Strategies Management of SCD is focused on preventing and treating pain episodes and other complications. Prevention strategies include lifestyle behaviors as well as medical screening and interventions to prevent SCD complications. Lifestyle Behaviors There are simple steps that people with SCD can take to help prevent and reduce the occurrence of pain crises, including the following: Drink plenty of water. Try not to get too hot or too cold. Try to avoid places or situations that cause exposure to high altitudes (for example, flying, mountain climbing, or cities with a high altitude). Try to avoid places or situations with exposure to low oxygen levels (for example, mountain climbing or exercising extremely hard, such as in military boot camp or when training for an athletic competition). Simple steps to prevent harmful infections include the following: Wash your hands often. Washing hands with soap and clean water many times each day is one of the best ways people with SCD, their family members, and other caregivers can help prevent an infection. Prepare food safely. Bacteria can be especially harmful to children with SCD. Medical Screenings & Interventions to Prevent SCD Complications Prevention of Infections Vaccines can protect against harmful infections. It is important that children with SCD get all regular childhood vaccines. Similarly, it is important for children and adults to get the flu vaccine every year, as well as the pneumococcal vaccine and any others recommended by a doctor. Penicillin greatly reduces the risk of infections in people with HbSS and has been shown to be even more effective when it is started earlier. To decrease the risk of infection, it’s important that young children with HbSS take penicillin (or other antibiotic prescribed by a doctor) every day until at least 5 years of age. Penicillin on a daily basis is usually not prescribed for children with other types of SCD unless the severity of the disease is similar to that of HbSS, such as HbS beta0-thalassemia. Prevention of Vision Loss Yearly visits to an eye doctor to look for damage to the retina (the part of your eye that senses light and sends images to your brain) are important for people with SCD to avoid vision loss. If possible, it’s best to see an eye doctor who specializes in diseases of the retina. If the retina is damaged by excessive blood vessel growth, laser treatment often can prevent further vision loss. Prevention of Stroke Children who are at risk for stroke can be identified using a special type of exam called transcranial Doppler ultrasound (TCD). If the child is found to have an abnormal TCD, a doctor might recommend frequent blood transfusions (a procedure in which new blood is put into a person’s body through a small plastic tube inserted into a person’s blood vessels) to help prevent a stroke. People who have frequent blood transfusions are usually watched closely because there can be serious side effects. For example, because blood contains iron, transfusions can lead to a condition called iron overload, in which too much iron builds up in the body. Iron overload can cause life-threatening damage to the liver, heart, and other organs. Therefore, it is important for people with SCD receiving regular blood transfusions to also receive treatment to reduce excess iron in the body. This type of treatment is known as iron chelation therapy. Prevention of Severe Anemia Blood transfusions may be used to treat severe anemia. A sudden worsening of anemia resulting from infection or enlargement of the spleen (an organ in the upper left side of the abdomen) is a common reason for a transfusion. As with preventing stroke, frequent blood transfusions can cause iron overload, and iron chelation therapy may be needed to reduce excess iron in the body. Management of Pain Crises When pain crises do occur, clinical management may include the following: Intravenous fluids (giving fluids directly into a person’s vein) Pain-reducing medicine Hospitalization for severe pain crises Specific Treatments to Prevent SCD Complications SCD is a disease that worsens over time. Treatments are available that can prevent complications and lengthen the lives of those who have this condition. These treatment options and their effects can be different for each person, depending on the symptoms and severity of their disease. It is important to understand the benefits and risks of each treatment option. Currently, the FDA has approved four treatments for SCD[1].
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{Task} If you cannot answer the question using the given text, respond with "The text does not contain what you are looking for." ================ {Text Passage} **What is Sickle Cell Disease?** Sickle cell disease (SCD) is a group of inherited red blood cell disorders. Red blood cells contain hemoglobin, a protein that carries oxygen. Healthy red blood cells are round, and they move through small blood vessels to carry oxygen to all parts of the body. In someone who has SCD, the hemoglobin is abnormal, which causes the red blood cells to become hard and sticky and look like a C-shaped farm tool called a “sickle.” The sickle cells die early, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, they get stuck and clog the blood flow. This can cause pain and other serious complications (health problems) such as infection, acute chest syndrome and stroke. Types of SCD There are several types of SCD. The specific type of SCD a person has depends on the genes they inherited from their parents. People with SCD inherit genes that contain instructions, or code, for abnormal hemoglobin. Below are the most common types of SCD: HbSS People who have this form of SCD inherit two genes, one from each parent, that code for hemoglobin “S.” Hemoglobin S is an abnormal form of hemoglobin that causes the red cells to become rigid, and sickle shaped. This is commonly called sickle cell anemia and is usually the most severe form of the disease. HbSC People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for a different type of abnormal hemoglobin called “C” from the other parent. This is usually a milder form of SCD. Infographic: 5 Facts You Should Know About Sickle Cell Disease Infographic: 5 Facts You Should Know About Sickle Cell Disease Did you know SCD affects people from many parts of the world? HbS beta thalassemia People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for beta thalassemia, another type of hemoglobin abnormality, from the other parent. There are two types of beta thalassemia: “zero” (HbS beta0) and “plus” (HbS beta+). Those with HbS beta0-thalassemia usually have a severe form of SCD. People with HbS beta+-thalassemia tend to have a milder form of SCD. There also are a few rare types of SCD, such as the following: HbSD, HbSE, and HbSO People who have these forms of SCD inherit one hemoglobin “S” gene and one gene that codes for another abnormal type of hemoglobin (“D”, “E”, or “O”). The severity of these rarer types of SCD varies. Sickle Cell Trait (SCT) HbAS People who have sickle cell trait (SCT) inherit a hemoglobin “S” gene from one parent and a normal gene (one that codes for hemoglobin “A”) from the other parent. People with SCT usually do not have any of the signs of the disease. However, in rare cases, a person with SCT may develop health problems; this occurs most often when there are other stresses on the body, such as when a person becomes dehydrated or exercises strenuously. Additionally, people who have SCT can pass the abnormal hemoglobin “S” gene on to their children. Cause of SCD SCD is a genetic condition that is present at birth. It is inherited when a child receives two genes—one from each parent—that code for abnormal hemoglobin. Diagnosis SCD is diagnosed with a simple blood test. In children born in the United States, it most often is found at birth during routine newborn screening tests at the hospital. In addition, SCD can be diagnosed while the baby is in the womb. Diagnostic tests before the baby is born, such as chorionic villus sampling and amniocentesis, can check for chromosomal or genetic abnormalities in the baby. Chorionic villus sampling tests a tiny piece of the placenta, called chorionic villus. Amniocentesis tests a small sample of amniotic fluid surrounding the baby. Because children with SCD are at an increased risk of infection and other health problems, early diagnosis and treatment are important. Complications People with SCD may start to have signs of the disease during the first year of life, usually around 5 months of age. Symptoms and complications of SCD are different for each person and can range from mild to severe. Learn about the complications. Prevention and Treatment of SCD Complications General Prevention Strategies Management of SCD is focused on preventing and treating pain episodes and other complications. Prevention strategies include lifestyle behaviors as well as medical screening and interventions to prevent SCD complications. Lifestyle Behaviors There are simple steps that people with SCD can take to help prevent and reduce the occurrence of pain crises, including the following: Drink plenty of water. Try not to get too hot or too cold. Try to avoid places or situations that cause exposure to high altitudes (for example, flying, mountain climbing, or cities with a high altitude). Try to avoid places or situations with exposure to low oxygen levels (for example, mountain climbing or exercising extremely hard, such as in military boot camp or when training for an athletic competition). Simple steps to prevent harmful infections include the following: Wash your hands often. Washing hands with soap and clean water many times each day is one of the best ways people with SCD, their family members, and other caregivers can help prevent an infection. Prepare food safely. Bacteria can be especially harmful to children with SCD. Medical Screenings & Interventions to Prevent SCD Complications Prevention of Infections Vaccines can protect against harmful infections. It is important that children with SCD get all regular childhood vaccines. Similarly, it is important for children and adults to get the flu vaccine every year, as well as the pneumococcal vaccine and any others recommended by a doctor. Penicillin greatly reduces the risk of infections in people with HbSS and has been shown to be even more effective when it is started earlier. To decrease the risk of infection, it’s important that young children with HbSS take penicillin (or other antibiotic prescribed by a doctor) every day until at least 5 years of age. Penicillin on a daily basis is usually not prescribed for children with other types of SCD unless the severity of the disease is similar to that of HbSS, such as HbS beta0-thalassemia. Prevention of Vision Loss Yearly visits to an eye doctor to look for damage to the retina (the part of your eye that senses light and sends images to your brain) are important for people with SCD to avoid vision loss. If possible, it’s best to see an eye doctor who specializes in diseases of the retina. If the retina is damaged by excessive blood vessel growth, laser treatment often can prevent further vision loss. Prevention of Stroke Children who are at risk for stroke can be identified using a special type of exam called transcranial Doppler ultrasound (TCD). If the child is found to have an abnormal TCD, a doctor might recommend frequent blood transfusions (a procedure in which new blood is put into a person’s body through a small plastic tube inserted into a person’s blood vessels) to help prevent a stroke. People who have frequent blood transfusions are usually watched closely because there can be serious side effects. For example, because blood contains iron, transfusions can lead to a condition called iron overload, in which too much iron builds up in the body. Iron overload can cause life-threatening damage to the liver, heart, and other organs. Therefore, it is important for people with SCD receiving regular blood transfusions to also receive treatment to reduce excess iron in the body. This type of treatment is known as iron chelation therapy. Prevention of Severe Anemia Blood transfusions may be used to treat severe anemia. A sudden worsening of anemia resulting from infection or enlargement of the spleen (an organ in the upper left side of the abdomen) is a common reason for a transfusion. As with preventing stroke, frequent blood transfusions can cause iron overload, and iron chelation therapy may be needed to reduce excess iron in the body. Management of Pain Crises When pain crises do occur, clinical management may include the following: Intravenous fluids (giving fluids directly into a person’s vein) Pain-reducing medicine Hospitalization for severe pain crises Specific Treatments to Prevent SCD Complications SCD is a disease that worsens over time. Treatments are available that can prevent complications and lengthen the lives of those who have this condition. These treatment options and their effects can be different for each person, depending on the symptoms and severity of their disease. It is important to understand the benefits and risks of each treatment option. Currently, the FDA has approved four treatments for SCD[1]. ================ {Question} Using only the provided text, Is Sickle Cell Disease hereditary?
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If you cannot answer the question using the given text, respond with "The text does not contain what you are looking for."
EVIDENCE:
**What is Sickle Cell Disease?** Sickle cell disease (SCD) is a group of inherited red blood cell disorders. Red blood cells contain hemoglobin, a protein that carries oxygen. Healthy red blood cells are round, and they move through small blood vessels to carry oxygen to all parts of the body. In someone who has SCD, the hemoglobin is abnormal, which causes the red blood cells to become hard and sticky and look like a C-shaped farm tool called a “sickle.” The sickle cells die early, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, they get stuck and clog the blood flow. This can cause pain and other serious complications (health problems) such as infection, acute chest syndrome and stroke. Types of SCD There are several types of SCD. The specific type of SCD a person has depends on the genes they inherited from their parents. People with SCD inherit genes that contain instructions, or code, for abnormal hemoglobin. Below are the most common types of SCD: HbSS People who have this form of SCD inherit two genes, one from each parent, that code for hemoglobin “S.” Hemoglobin S is an abnormal form of hemoglobin that causes the red cells to become rigid, and sickle shaped. This is commonly called sickle cell anemia and is usually the most severe form of the disease. HbSC People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for a different type of abnormal hemoglobin called “C” from the other parent. This is usually a milder form of SCD. Infographic: 5 Facts You Should Know About Sickle Cell Disease Infographic: 5 Facts You Should Know About Sickle Cell Disease Did you know SCD affects people from many parts of the world? HbS beta thalassemia People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for beta thalassemia, another type of hemoglobin abnormality, from the other parent. There are two types of beta thalassemia: “zero” (HbS beta0) and “plus” (HbS beta+). Those with HbS beta0-thalassemia usually have a severe form of SCD. People with HbS beta+-thalassemia tend to have a milder form of SCD. There also are a few rare types of SCD, such as the following: HbSD, HbSE, and HbSO People who have these forms of SCD inherit one hemoglobin “S” gene and one gene that codes for another abnormal type of hemoglobin (“D”, “E”, or “O”). The severity of these rarer types of SCD varies. Sickle Cell Trait (SCT) HbAS People who have sickle cell trait (SCT) inherit a hemoglobin “S” gene from one parent and a normal gene (one that codes for hemoglobin “A”) from the other parent. People with SCT usually do not have any of the signs of the disease. However, in rare cases, a person with SCT may develop health problems; this occurs most often when there are other stresses on the body, such as when a person becomes dehydrated or exercises strenuously. Additionally, people who have SCT can pass the abnormal hemoglobin “S” gene on to their children. Cause of SCD SCD is a genetic condition that is present at birth. It is inherited when a child receives two genes—one from each parent—that code for abnormal hemoglobin. Diagnosis SCD is diagnosed with a simple blood test. In children born in the United States, it most often is found at birth during routine newborn screening tests at the hospital. In addition, SCD can be diagnosed while the baby is in the womb. Diagnostic tests before the baby is born, such as chorionic villus sampling and amniocentesis, can check for chromosomal or genetic abnormalities in the baby. Chorionic villus sampling tests a tiny piece of the placenta, called chorionic villus. Amniocentesis tests a small sample of amniotic fluid surrounding the baby. Because children with SCD are at an increased risk of infection and other health problems, early diagnosis and treatment are important. Complications People with SCD may start to have signs of the disease during the first year of life, usually around 5 months of age. Symptoms and complications of SCD are different for each person and can range from mild to severe. Learn about the complications. Prevention and Treatment of SCD Complications General Prevention Strategies Management of SCD is focused on preventing and treating pain episodes and other complications. Prevention strategies include lifestyle behaviors as well as medical screening and interventions to prevent SCD complications. Lifestyle Behaviors There are simple steps that people with SCD can take to help prevent and reduce the occurrence of pain crises, including the following: Drink plenty of water. Try not to get too hot or too cold. Try to avoid places or situations that cause exposure to high altitudes (for example, flying, mountain climbing, or cities with a high altitude). Try to avoid places or situations with exposure to low oxygen levels (for example, mountain climbing or exercising extremely hard, such as in military boot camp or when training for an athletic competition). Simple steps to prevent harmful infections include the following: Wash your hands often. Washing hands with soap and clean water many times each day is one of the best ways people with SCD, their family members, and other caregivers can help prevent an infection. Prepare food safely. Bacteria can be especially harmful to children with SCD. Medical Screenings & Interventions to Prevent SCD Complications Prevention of Infections Vaccines can protect against harmful infections. It is important that children with SCD get all regular childhood vaccines. Similarly, it is important for children and adults to get the flu vaccine every year, as well as the pneumococcal vaccine and any others recommended by a doctor. Penicillin greatly reduces the risk of infections in people with HbSS and has been shown to be even more effective when it is started earlier. To decrease the risk of infection, it’s important that young children with HbSS take penicillin (or other antibiotic prescribed by a doctor) every day until at least 5 years of age. Penicillin on a daily basis is usually not prescribed for children with other types of SCD unless the severity of the disease is similar to that of HbSS, such as HbS beta0-thalassemia. Prevention of Vision Loss Yearly visits to an eye doctor to look for damage to the retina (the part of your eye that senses light and sends images to your brain) are important for people with SCD to avoid vision loss. If possible, it’s best to see an eye doctor who specializes in diseases of the retina. If the retina is damaged by excessive blood vessel growth, laser treatment often can prevent further vision loss. Prevention of Stroke Children who are at risk for stroke can be identified using a special type of exam called transcranial Doppler ultrasound (TCD). If the child is found to have an abnormal TCD, a doctor might recommend frequent blood transfusions (a procedure in which new blood is put into a person’s body through a small plastic tube inserted into a person’s blood vessels) to help prevent a stroke. People who have frequent blood transfusions are usually watched closely because there can be serious side effects. For example, because blood contains iron, transfusions can lead to a condition called iron overload, in which too much iron builds up in the body. Iron overload can cause life-threatening damage to the liver, heart, and other organs. Therefore, it is important for people with SCD receiving regular blood transfusions to also receive treatment to reduce excess iron in the body. This type of treatment is known as iron chelation therapy. Prevention of Severe Anemia Blood transfusions may be used to treat severe anemia. A sudden worsening of anemia resulting from infection or enlargement of the spleen (an organ in the upper left side of the abdomen) is a common reason for a transfusion. As with preventing stroke, frequent blood transfusions can cause iron overload, and iron chelation therapy may be needed to reduce excess iron in the body. Management of Pain Crises When pain crises do occur, clinical management may include the following: Intravenous fluids (giving fluids directly into a person’s vein) Pain-reducing medicine Hospitalization for severe pain crises Specific Treatments to Prevent SCD Complications SCD is a disease that worsens over time. Treatments are available that can prevent complications and lengthen the lives of those who have this condition. These treatment options and their effects can be different for each person, depending on the symptoms and severity of their disease. It is important to understand the benefits and risks of each treatment option. Currently, the FDA has approved four treatments for SCD[1].
USER:
Using only the provided text, Is Sickle Cell Disease hereditary?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 22 | 10 | 1,450 | null | 841 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
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What are the reasons for why I would choose a cash secured put over a covered call? Compare their advantages and disadvantages assuming I don't have a capital requirement.
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What Is a Cash Secured Put? A cash-secured put involves writing a put option on a particular stock and securing the position with enough cash reserves to cover the purchase of shares should the option be exercised. The amount of cash required is equal to 100 shares of the stock at the option’s strike price. If the stock’s price remains above the strike price, the option expires worthless, and the investor keeps the premium. If the stock price drops below the strike price, the investor buys the stock at the lower price. What Is a Covered Call? A covered call is a strategy where an investor owns the underlying stock and sells a call option on it. This involves buying 100 shares of a stock and selling a call option with a strike price at or above the purchase price. If the stock’s price remains flat or declines, the investor keeps the premium, and the option expires worthless. If the stock’s price rises above the strike price, the investor sells the shares at the strike price, securing the option premium plus any capital gains up to the strike price. Cash Secured Put vs Covered Call – The Differences You Should Know Primary Motives: An investor using a cash-secured put has a neutral outlook but is prepared to buy shares at a lower price. A covered call suits an investor who already owns the stock and seeks to earn extra income from the option premium. Market Outlook: Choosing a cash secured put vs covered call requires to consider your outlook on the market (or, at least, on a company). Both trades have definitely a bullish orientation. Possible Profits: Cash-secured put sellers profit only from the option premium. Covered call sellers can profit from both the option premiums and any stock dividends or appreciation if the stock price rises above the strike price. Dividends: When debating cash secured put vs covered call, dividends are an aspect you cannot ignore. Covered calls allow investors to collect dividends since they own the underlying stock. Cash-secured puts do not offer this benefit as the stock is not owned unless the option is exercised. Time Horizon: Usually, a covered call is better for longer term positions, while the cash secured put will work best for shorter term operations, especially considering what we said above about dividends. If you understand these dynamics, you can effectively use cash secured puts to enhance your portfolio, balancing risk and reward based on your market outlook and investment goals. We gave you a rather practical approach to open an options trade, just make sure you do your homework before by carefully researching the company. You can also use our “High probability naked puts (85% prob of worthless, good companies, good risk-return profile)” predefined scan (you’ll find a link to it at the end of the article) to speed up the process, but this does not mean you should skip doing your own analysis. Cash Secured Put vs Covered Call – Picking the Right Strategy in the Right Moment Having seen the two examples above, it is now easier to draw some conclusions on when to use a cash secured put vs covered call strategy. Market Conditions Choosing between covered calls vs cash secured puts often depends on the market conditions. Both strategies benefit from bullish conditions, but a cash-secured put will leave the door open for a potential share assignment at a lower price if the stock price moves below the strike price, while a covered call requires you to buy the shares at once and sell a call right away. By owning the underlying stock, you can capitalize on both the premium from selling the call option and any appreciation in the stock price. In low-volatility markets, both strategies (cash secured put vs covered call) can provide a steady income stream, but understanding the market’s direction can help you select the optimal strategy. Investor Goals Investor goals and risk tolerance are crucial in the decision-making process. If your goal is to invest for the longer term, maybe a covered call will be the wisest choice (think, for instance, about the fact that you can receive a dividend). However, if you’re thinking about a shorter term position, the cash secured put works best. When looking at choosing between covered calls vs cash secured puts, consider that, if you own shares and seek to generate extra income with a bullish outlook, covered calls are a suitable choice. This approach lets you benefit from premiums and potential stock gains. Understanding your investment goals, whether it is acquiring new stocks or maximizing returns on existing holdings, will guide you in choosing between covered calls and cash secured puts.
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What are the reasons for why I would choose a cash secured put over a covered call? Compare their advantages and disadvantages assuming I don't have a capital requirement. {passage 0} ========== What Is a Cash Secured Put? A cash-secured put involves writing a put option on a particular stock and securing the position with enough cash reserves to cover the purchase of shares should the option be exercised. The amount of cash required is equal to 100 shares of the stock at the option’s strike price. If the stock’s price remains above the strike price, the option expires worthless, and the investor keeps the premium. If the stock price drops below the strike price, the investor buys the stock at the lower price. What Is a Covered Call? A covered call is a strategy where an investor owns the underlying stock and sells a call option on it. This involves buying 100 shares of a stock and selling a call option with a strike price at or above the purchase price. If the stock’s price remains flat or declines, the investor keeps the premium, and the option expires worthless. If the stock’s price rises above the strike price, the investor sells the shares at the strike price, securing the option premium plus any capital gains up to the strike price. Cash Secured Put vs Covered Call – The Differences You Should Know Primary Motives: An investor using a cash-secured put has a neutral outlook but is prepared to buy shares at a lower price. A covered call suits an investor who already owns the stock and seeks to earn extra income from the option premium. Market Outlook: Choosing a cash secured put vs covered call requires to consider your outlook on the market (or, at least, on a company). Both trades have definitely a bullish orientation. Possible Profits: Cash-secured put sellers profit only from the option premium. Covered call sellers can profit from both the option premiums and any stock dividends or appreciation if the stock price rises above the strike price. Dividends: When debating cash secured put vs covered call, dividends are an aspect you cannot ignore. Covered calls allow investors to collect dividends since they own the underlying stock. Cash-secured puts do not offer this benefit as the stock is not owned unless the option is exercised. Time Horizon: Usually, a covered call is better for longer term positions, while the cash secured put will work best for shorter term operations, especially considering what we said above about dividends. If you understand these dynamics, you can effectively use cash secured puts to enhance your portfolio, balancing risk and reward based on your market outlook and investment goals. We gave you a rather practical approach to open an options trade, just make sure you do your homework before by carefully researching the company. You can also use our “High probability naked puts (85% prob of worthless, good companies, good risk-return profile)” predefined scan (you’ll find a link to it at the end of the article) to speed up the process, but this does not mean you should skip doing your own analysis. Cash Secured Put vs Covered Call – Picking the Right Strategy in the Right Moment Having seen the two examples above, it is now easier to draw some conclusions on when to use a cash secured put vs covered call strategy. Market Conditions Choosing between covered calls vs cash secured puts often depends on the market conditions. Both strategies benefit from bullish conditions, but a cash-secured put will leave the door open for a potential share assignment at a lower price if the stock price moves below the strike price, while a covered call requires you to buy the shares at once and sell a call right away. By owning the underlying stock, you can capitalize on both the premium from selling the call option and any appreciation in the stock price. In low-volatility markets, both strategies (cash secured put vs covered call) can provide a steady income stream, but understanding the market’s direction can help you select the optimal strategy. Investor Goals Investor goals and risk tolerance are crucial in the decision-making process. If your goal is to invest for the longer term, maybe a covered call will be the wisest choice (think, for instance, about the fact that you can receive a dividend). However, if you’re thinking about a shorter term position, the cash secured put works best. When looking at choosing between covered calls vs cash secured puts, consider that, if you own shares and seek to generate extra income with a bullish outlook, covered calls are a suitable choice. This approach lets you benefit from premiums and potential stock gains. Understanding your investment goals, whether it is acquiring new stocks or maximizing returns on existing holdings, will guide you in choosing between covered calls and cash secured puts. https://blog.optionsamurai.com/cash-secured-put-vs-covered-call/#:~:text=Both%20strategies%20benefit%20from%20bullish,sell%20a%20call%20right%20away.
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
What Is a Cash Secured Put? A cash-secured put involves writing a put option on a particular stock and securing the position with enough cash reserves to cover the purchase of shares should the option be exercised. The amount of cash required is equal to 100 shares of the stock at the option’s strike price. If the stock’s price remains above the strike price, the option expires worthless, and the investor keeps the premium. If the stock price drops below the strike price, the investor buys the stock at the lower price. What Is a Covered Call? A covered call is a strategy where an investor owns the underlying stock and sells a call option on it. This involves buying 100 shares of a stock and selling a call option with a strike price at or above the purchase price. If the stock’s price remains flat or declines, the investor keeps the premium, and the option expires worthless. If the stock’s price rises above the strike price, the investor sells the shares at the strike price, securing the option premium plus any capital gains up to the strike price. Cash Secured Put vs Covered Call – The Differences You Should Know Primary Motives: An investor using a cash-secured put has a neutral outlook but is prepared to buy shares at a lower price. A covered call suits an investor who already owns the stock and seeks to earn extra income from the option premium. Market Outlook: Choosing a cash secured put vs covered call requires to consider your outlook on the market (or, at least, on a company). Both trades have definitely a bullish orientation. Possible Profits: Cash-secured put sellers profit only from the option premium. Covered call sellers can profit from both the option premiums and any stock dividends or appreciation if the stock price rises above the strike price. Dividends: When debating cash secured put vs covered call, dividends are an aspect you cannot ignore. Covered calls allow investors to collect dividends since they own the underlying stock. Cash-secured puts do not offer this benefit as the stock is not owned unless the option is exercised. Time Horizon: Usually, a covered call is better for longer term positions, while the cash secured put will work best for shorter term operations, especially considering what we said above about dividends. If you understand these dynamics, you can effectively use cash secured puts to enhance your portfolio, balancing risk and reward based on your market outlook and investment goals. We gave you a rather practical approach to open an options trade, just make sure you do your homework before by carefully researching the company. You can also use our “High probability naked puts (85% prob of worthless, good companies, good risk-return profile)” predefined scan (you’ll find a link to it at the end of the article) to speed up the process, but this does not mean you should skip doing your own analysis. Cash Secured Put vs Covered Call – Picking the Right Strategy in the Right Moment Having seen the two examples above, it is now easier to draw some conclusions on when to use a cash secured put vs covered call strategy. Market Conditions Choosing between covered calls vs cash secured puts often depends on the market conditions. Both strategies benefit from bullish conditions, but a cash-secured put will leave the door open for a potential share assignment at a lower price if the stock price moves below the strike price, while a covered call requires you to buy the shares at once and sell a call right away. By owning the underlying stock, you can capitalize on both the premium from selling the call option and any appreciation in the stock price. In low-volatility markets, both strategies (cash secured put vs covered call) can provide a steady income stream, but understanding the market’s direction can help you select the optimal strategy. Investor Goals Investor goals and risk tolerance are crucial in the decision-making process. If your goal is to invest for the longer term, maybe a covered call will be the wisest choice (think, for instance, about the fact that you can receive a dividend). However, if you’re thinking about a shorter term position, the cash secured put works best. When looking at choosing between covered calls vs cash secured puts, consider that, if you own shares and seek to generate extra income with a bullish outlook, covered calls are a suitable choice. This approach lets you benefit from premiums and potential stock gains. Understanding your investment goals, whether it is acquiring new stocks or maximizing returns on existing holdings, will guide you in choosing between covered calls and cash secured puts.
USER:
What are the reasons for why I would choose a cash secured put over a covered call? Compare their advantages and disadvantages assuming I don't have a capital requirement.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 29 | 784 | null | 427 |
This task requires that you answer the following question based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge.
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How did the introduction of the 16-bit Intel 8088 microprocessor contribute to the rise of personal computers in mainstream business use?
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The microprocessor, or CPU, as some people call it, is the brains of our personal computer. I’m getting into this history lesson not because I’m a history buff (though computers do have a wonderfully interesting past), but to go through the development step-by-step to explain how they work. Well, not everything about how they work, but enough to understand the importance of the latest features and what they do for you. It’s going to take more than one article to dig into the inner secrets of microprocessors. I hope it’s an interesting read for you and helps you recognize computer buzzwords when you’re making your next computer purchase. 1. Where Did CPUs Come From? When the 1970s dawned, computers were still monster machines hidden in air-conditioned rooms and attended to by technicians in white lab coats. One component of a mainframe computer, as they were known, was the CPU, or Central Processing Unit. This was a steel cabinet bigger than a refrigerator full of circuit boards crowded with transistors. Computers had only recently been converted from vacuum tubes to transistors and only the very latest machines used primitive integrated circuits where a few transistors were gathered in one package. That means the CPU was a big pile of equipment. The thought that the CPU could be reduced to a chip of silicon the size of your fingernail was the stuff of science fiction. 2. How Does a CPU Work? In the '40s, mathematicians John Von Neumann, J. Presper Eckert and John Mauchly came up with the concept of the stored instruction digital computer. Before then, computers were programmed by rewiring their circuits to perform a certain calculation over and over. By having a memory and storing a set of instructions that can be performed over and over, as well as logic to vary the path of instruction, execution programmable computers were possible. The component of the computer that fetches the instructions and data from the memory and carries out the instructions in the form of data manipulation and numerical calculations is called the CPU. It’s central because all the memory and the input/output devices must connect to the CPU, so it’s only natural to keep the cables short to put the CPU in the middle. It does all the instruction execution and number calculations so it’s called the Processing Unit. The CPU has a program counter that points to the next instruction to be executed. It goes through a cycle where it retrieves, from memory, the instructions in the program counter. It then retrieves the required data from memory, performs the calculation indicated by the instruction and stores the result. The program counter is incremented to point to the next instruction and the cycle starts all over. 3. The First Microprocessor In 1971 when the heavy iron mainframe computers still ruled, a small Silicon Valley company was contracted to design an integrated circuit for a business calculator for Busicom. Instead of hardwired calculations like other calculator chips of the day, this one was designed as a tiny CPU that could be programmed to perform almost any calculation. The expensive and time-consuming work of designing a custom wired chip was replaced by the flexible 4004 microprocessor and the instructions stored in a separate ROM (Read Only Memory) chip. A new calculator with entirely new features can be created simply by programming a new ROM chip. The company that started this revolution was Intel Corporation. The concept of a general purpose CPU chip grew up to be the microprocessor that is the heart of your powerful PC. 4. 4 Bits Isn’t Enough The original 4004 microprocessor chip handled data in four bit chunks. Four bits gives you sixteen possible numbers, enough to handle standard decimal arithmetic for a calculator. If it were only the size of the numbers we calculate with, we might still be using four bit microprocessors. The problem is that there is another form of calculation a stored instruction computer needs to do. That is it has to figure out where in memory instructions are. In other words, it has to calculate memory locations to process program branch instructions or to index into tables of data. Like I said, four bits only gets you sixteen possibilities and even the 4004 needed to address 640 bytes of memory to handle calculator functions. Modern microprocessor chips like the Intel Pentium 4 can address 18,446,744,073,709,551,616 bytes of memory, though the motherboard is limited to less than this total. This led to the push for more bits in our microprocessors. We are now on the fence between 32 bit microprocessors and 64 bit monsters like the AMD Athlon 64. 5. The First Step Up, 8 Bits With a total memory address space of 640 bytes, the Intel 4004 chip was not the first microprocessor to be the starting point for a personal computer. In 1972, Intel delivered the 8008, a scaled up 4004. The 8008 was the first of many 8- bit microprocessors to fuel the home computer revolution. It was limited to only 16 Kilobytes of address space, but in those days no one could afford that much RAM. Two years later, Intel introduced the 8080 microprocessor with 64 Kilobytes of memory space and increased the rate of execution by a factor of ten over the 8008. About this time, Motorola brought out the 6800 with similar performance. The 8080 became the core of serious microcomputers that led to the Intel 8088 used in the IBM PC, while the 6800 family headed in the direction of the Apple II personal computer. 6. 16 Bits Enables the IBM PC By the late '70s, the personal computer was bursting at the seams of the 8 bit microprocessor performance. In 1979, Intel delivered the 8088 and IBM engineers used it for the first PC. The combination of the new 16 bit microprocessor and the name IBM shifted the personal computer from a techie toy in the garage to a mainstream business tool. The major advantage of the 8086 was up to 1 Megabyte of memory addressing. Now, large spreadsheets or large documents could be read in from the disk and held in RAM memory for fast access and manipulation. These days, it’s not uncommon to have a thousand times more than that in a single 1 Gigabyte RAM Module, but back in that time it put the IBM PC in the same league with minicomputers the size of a refrigerator. 7. Cache RAM, Catching Up With the CPU We’ll have to continue the march through the lineup of microprocessors in the next installment to make way for the first of the enhancements that you should understand. With memory space expanding and the speed of microprocessor cores going ever faster, there was a problem of the memory keeping up. Large low-powered memories cannot go as fast as smaller higher power RAM chips. To keep the fastest CPUs running full speed, microprocessor engineers started inserting a few of the fast and small memories between the main large RAM and the microprocessor. The purpose of this smaller memory is to hold instructions that get repeatedly executed or data that is accessed often. This smaller memory is called cache RAM and allows the microprocessor to execute at full speed. Naturally, the larger the cache RAM the higher percentage of cache hits and the microprocessor can continue running full speed. When the program execution leads to instructions not in the cache, then the instructions need to be fetched from the main memory and the microprocessor has to stop and wait. 8. Cache Grows Up The idea of cache RAM has grown along with the size and complexity of microprocessor chips. A high-end Pentium 4has 2 Megabytes of cache RAM built into the chip. That’s more than twice the entire memory address space of the original 8088 chip used in the first PC and clones. Putting the cache right on the microprocessor itself removes the slowdown of the wires between chips. You know you are going fast when the speed of light for a few inches makes a difference!
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System instruction: [This task requires that you answer the following question based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge. ] Question: [How did the introduction of the 16-bit Intel 8088 microprocessor contribute to the rise of personal computers in mainstream business use?] Context: [The microprocessor, or CPU, as some people call it, is the brains of our personal computer. I’m getting into this history lesson not because I’m a history buff (though computers do have a wonderfully interesting past), but to go through the development step-by-step to explain how they work. Well, not everything about how they work, but enough to understand the importance of the latest features and what they do for you. It’s going to take more than one article to dig into the inner secrets of microprocessors. I hope it’s an interesting read for you and helps you recognize computer buzzwords when you’re making your next computer purchase. 1. Where Did CPUs Come From? When the 1970s dawned, computers were still monster machines hidden in air-conditioned rooms and attended to by technicians in white lab coats. One component of a mainframe computer, as they were known, was the CPU, or Central Processing Unit. This was a steel cabinet bigger than a refrigerator full of circuit boards crowded with transistors. Computers had only recently been converted from vacuum tubes to transistors and only the very latest machines used primitive integrated circuits where a few transistors were gathered in one package. That means the CPU was a big pile of equipment. The thought that the CPU could be reduced to a chip of silicon the size of your fingernail was the stuff of science fiction. 2. How Does a CPU Work? In the '40s, mathematicians John Von Neumann, J. Presper Eckert and John Mauchly came up with the concept of the stored instruction digital computer. Before then, computers were programmed by rewiring their circuits to perform a certain calculation over and over. By having a memory and storing a set of instructions that can be performed over and over, as well as logic to vary the path of instruction, execution programmable computers were possible. The component of the computer that fetches the instructions and data from the memory and carries out the instructions in the form of data manipulation and numerical calculations is called the CPU. It’s central because all the memory and the input/output devices must connect to the CPU, so it’s only natural to keep the cables short to put the CPU in the middle. It does all the instruction execution and number calculations so it’s called the Processing Unit. The CPU has a program counter that points to the next instruction to be executed. It goes through a cycle where it retrieves, from memory, the instructions in the program counter. It then retrieves the required data from memory, performs the calculation indicated by the instruction and stores the result. The program counter is incremented to point to the next instruction and the cycle starts all over. 3. The First Microprocessor In 1971 when the heavy iron mainframe computers still ruled, a small Silicon Valley company was contracted to design an integrated circuit for a business calculator for Busicom. Instead of hardwired calculations like other calculator chips of the day, this one was designed as a tiny CPU that could be programmed to perform almost any calculation. The expensive and time-consuming work of designing a custom wired chip was replaced by the flexible 4004 microprocessor and the instructions stored in a separate ROM (Read Only Memory) chip. A new calculator with entirely new features can be created simply by programming a new ROM chip. The company that started this revolution was Intel Corporation. The concept of a general purpose CPU chip grew up to be the microprocessor that is the heart of your powerful PC. 4. 4 Bits Isn’t Enough The original 4004 microprocessor chip handled data in four bit chunks. Four bits gives you sixteen possible numbers, enough to handle standard decimal arithmetic for a calculator. If it were only the size of the numbers we calculate with, we might still be using four bit microprocessors. The problem is that there is another form of calculation a stored instruction computer needs to do. That is it has to figure out where in memory instructions are. In other words, it has to calculate memory locations to process program branch instructions or to index into tables of data. Like I said, four bits only gets you sixteen possibilities and even the 4004 needed to address 640 bytes of memory to handle calculator functions. Modern microprocessor chips like the Intel Pentium 4 can address 18,446,744,073,709,551,616 bytes of memory, though the motherboard is limited to less than this total. This led to the push for more bits in our microprocessors. We are now on the fence between 32 bit microprocessors and 64 bit monsters like the AMD Athlon 64. 5. The First Step Up, 8 Bits With a total memory address space of 640 bytes, the Intel 4004 chip was not the first microprocessor to be the starting point for a personal computer. In 1972, Intel delivered the 8008, a scaled up 4004. The 8008 was the first of many 8- bit microprocessors to fuel the home computer revolution. It was limited to only 16 Kilobytes of address space, but in those days no one could afford that much RAM. Two years later, Intel introduced the 8080 microprocessor with 64 Kilobytes of memory space and increased the rate of execution by a factor of ten over the 8008. About this time, Motorola brought out the 6800 with similar performance. The 8080 became the core of serious microcomputers that led to the Intel 8088 used in the IBM PC, while the 6800 family headed in the direction of the Apple II personal computer. 6. 16 Bits Enables the IBM PC By the late '70s, the personal computer was bursting at the seams of the 8 bit microprocessor performance. In 1979, Intel delivered the 8088 and IBM engineers used it for the first PC. The combination of the new 16 bit microprocessor and the name IBM shifted the personal computer from a techie toy in the garage to a mainstream business tool. The major advantage of the 8086 was up to 1 Megabyte of memory addressing. Now, large spreadsheets or large documents could be read in from the disk and held in RAM memory for fast access and manipulation. These days, it’s not uncommon to have a thousand times more than that in a single 1 Gigabyte RAM Module, but back in that time it put the IBM PC in the same league with minicomputers the size of a refrigerator. 7. Cache RAM, Catching Up With the CPU We’ll have to continue the march through the lineup of microprocessors in the next installment to make way for the first of the enhancements that you should understand. With memory space expanding and the speed of microprocessor cores going ever faster, there was a problem of the memory keeping up. Large low-powered memories cannot go as fast as smaller higher power RAM chips. To keep the fastest CPUs running full speed, microprocessor engineers started inserting a few of the fast and small memories between the main large RAM and the microprocessor. The purpose of this smaller memory is to hold instructions that get repeatedly executed or data that is accessed often. This smaller memory is called cache RAM and allows the microprocessor to execute at full speed. Naturally, the larger the cache RAM the higher percentage of cache hits and the microprocessor can continue running full speed. When the program execution leads to instructions not in the cache, then the instructions need to be fetched from the main memory and the microprocessor has to stop and wait. 8. Cache Grows Up The idea of cache RAM has grown along with the size and complexity of microprocessor chips. A high-end Pentium 4has 2 Megabytes of cache RAM built into the chip. That’s more than twice the entire memory address space of the original 8088 chip used in the first PC and clones. Putting the cache right on the microprocessor itself removes the slowdown of the wires between chips. You know you are going fast when the speed of light for a few inches makes a difference!]
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This task requires that you answer the following question based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge.
EVIDENCE:
The microprocessor, or CPU, as some people call it, is the brains of our personal computer. I’m getting into this history lesson not because I’m a history buff (though computers do have a wonderfully interesting past), but to go through the development step-by-step to explain how they work. Well, not everything about how they work, but enough to understand the importance of the latest features and what they do for you. It’s going to take more than one article to dig into the inner secrets of microprocessors. I hope it’s an interesting read for you and helps you recognize computer buzzwords when you’re making your next computer purchase. 1. Where Did CPUs Come From? When the 1970s dawned, computers were still monster machines hidden in air-conditioned rooms and attended to by technicians in white lab coats. One component of a mainframe computer, as they were known, was the CPU, or Central Processing Unit. This was a steel cabinet bigger than a refrigerator full of circuit boards crowded with transistors. Computers had only recently been converted from vacuum tubes to transistors and only the very latest machines used primitive integrated circuits where a few transistors were gathered in one package. That means the CPU was a big pile of equipment. The thought that the CPU could be reduced to a chip of silicon the size of your fingernail was the stuff of science fiction. 2. How Does a CPU Work? In the '40s, mathematicians John Von Neumann, J. Presper Eckert and John Mauchly came up with the concept of the stored instruction digital computer. Before then, computers were programmed by rewiring their circuits to perform a certain calculation over and over. By having a memory and storing a set of instructions that can be performed over and over, as well as logic to vary the path of instruction, execution programmable computers were possible. The component of the computer that fetches the instructions and data from the memory and carries out the instructions in the form of data manipulation and numerical calculations is called the CPU. It’s central because all the memory and the input/output devices must connect to the CPU, so it’s only natural to keep the cables short to put the CPU in the middle. It does all the instruction execution and number calculations so it’s called the Processing Unit. The CPU has a program counter that points to the next instruction to be executed. It goes through a cycle where it retrieves, from memory, the instructions in the program counter. It then retrieves the required data from memory, performs the calculation indicated by the instruction and stores the result. The program counter is incremented to point to the next instruction and the cycle starts all over. 3. The First Microprocessor In 1971 when the heavy iron mainframe computers still ruled, a small Silicon Valley company was contracted to design an integrated circuit for a business calculator for Busicom. Instead of hardwired calculations like other calculator chips of the day, this one was designed as a tiny CPU that could be programmed to perform almost any calculation. The expensive and time-consuming work of designing a custom wired chip was replaced by the flexible 4004 microprocessor and the instructions stored in a separate ROM (Read Only Memory) chip. A new calculator with entirely new features can be created simply by programming a new ROM chip. The company that started this revolution was Intel Corporation. The concept of a general purpose CPU chip grew up to be the microprocessor that is the heart of your powerful PC. 4. 4 Bits Isn’t Enough The original 4004 microprocessor chip handled data in four bit chunks. Four bits gives you sixteen possible numbers, enough to handle standard decimal arithmetic for a calculator. If it were only the size of the numbers we calculate with, we might still be using four bit microprocessors. The problem is that there is another form of calculation a stored instruction computer needs to do. That is it has to figure out where in memory instructions are. In other words, it has to calculate memory locations to process program branch instructions or to index into tables of data. Like I said, four bits only gets you sixteen possibilities and even the 4004 needed to address 640 bytes of memory to handle calculator functions. Modern microprocessor chips like the Intel Pentium 4 can address 18,446,744,073,709,551,616 bytes of memory, though the motherboard is limited to less than this total. This led to the push for more bits in our microprocessors. We are now on the fence between 32 bit microprocessors and 64 bit monsters like the AMD Athlon 64. 5. The First Step Up, 8 Bits With a total memory address space of 640 bytes, the Intel 4004 chip was not the first microprocessor to be the starting point for a personal computer. In 1972, Intel delivered the 8008, a scaled up 4004. The 8008 was the first of many 8- bit microprocessors to fuel the home computer revolution. It was limited to only 16 Kilobytes of address space, but in those days no one could afford that much RAM. Two years later, Intel introduced the 8080 microprocessor with 64 Kilobytes of memory space and increased the rate of execution by a factor of ten over the 8008. About this time, Motorola brought out the 6800 with similar performance. The 8080 became the core of serious microcomputers that led to the Intel 8088 used in the IBM PC, while the 6800 family headed in the direction of the Apple II personal computer. 6. 16 Bits Enables the IBM PC By the late '70s, the personal computer was bursting at the seams of the 8 bit microprocessor performance. In 1979, Intel delivered the 8088 and IBM engineers used it for the first PC. The combination of the new 16 bit microprocessor and the name IBM shifted the personal computer from a techie toy in the garage to a mainstream business tool. The major advantage of the 8086 was up to 1 Megabyte of memory addressing. Now, large spreadsheets or large documents could be read in from the disk and held in RAM memory for fast access and manipulation. These days, it’s not uncommon to have a thousand times more than that in a single 1 Gigabyte RAM Module, but back in that time it put the IBM PC in the same league with minicomputers the size of a refrigerator. 7. Cache RAM, Catching Up With the CPU We’ll have to continue the march through the lineup of microprocessors in the next installment to make way for the first of the enhancements that you should understand. With memory space expanding and the speed of microprocessor cores going ever faster, there was a problem of the memory keeping up. Large low-powered memories cannot go as fast as smaller higher power RAM chips. To keep the fastest CPUs running full speed, microprocessor engineers started inserting a few of the fast and small memories between the main large RAM and the microprocessor. The purpose of this smaller memory is to hold instructions that get repeatedly executed or data that is accessed often. This smaller memory is called cache RAM and allows the microprocessor to execute at full speed. Naturally, the larger the cache RAM the higher percentage of cache hits and the microprocessor can continue running full speed. When the program execution leads to instructions not in the cache, then the instructions need to be fetched from the main memory and the microprocessor has to stop and wait. 8. Cache Grows Up The idea of cache RAM has grown along with the size and complexity of microprocessor chips. A high-end Pentium 4has 2 Megabytes of cache RAM built into the chip. That’s more than twice the entire memory address space of the original 8088 chip used in the first PC and clones. Putting the cache right on the microprocessor itself removes the slowdown of the wires between chips. You know you are going fast when the speed of light for a few inches makes a difference!
USER:
How did the introduction of the 16-bit Intel 8088 microprocessor contribute to the rise of personal computers in mainstream business use?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
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What would you recommend as the top 3 best credit cards if I travel a lot, don't eat at restaurants and don't want to pay any annual fees?
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Best no-annual-fee credit cards The best credit cards with no annual fee give people a chance to earn rewards and build credit without breaking the bank. Chase Freedom Flex℠: With no annual fee, you won’t have to pay for bonus cash back. Find out what others think in member reviews of Chase Freedom Flex℠. Chase Freedom Unlimited®: For a card with no annual fee, you could earn quite a bit of cash back for your everyday purchases. Take a look at our review of Chase Freedom Unlimited® to see how. Citi Double Cash® Card: You’ll earn cash back at a high rate overall without paying an annual fee. Learn more in our review of the Citi Double Cash® Card. Best cash back credit cards The best cash back credit cards offer reward categories that fit your spending habits. Chase Freedom Flex℠: You can maximize your cash back in a new bonus category every quarter. Check out reviews to see what members think of Chase Freedom Flex℠ and learn more about the current bonus categories. Chase Freedom Unlimited®: This card is worth a look if you want a high rewards rate on everyday purchases and several bonus categories. Take a look at our Chase Freedom Unlimited® review to learn more. Citi Double Cash® Card: This card makes earning cash back simple with a flat rate on all purchases. Find out more in our review of Citi Double Cash® Card. Best travel credit cards The best travel credit cards could help you save up for a future vacation. Bank of America® Premium Rewards® credit card: Quality rewards and several valuable perks give this card a nice value for the annual fee. Find out what sets this card apart in our review of the Bank of America® Premium Rewards® credit card. Chase Sapphire Preferred® Card: The flexible travel rewards could help you book your next vacation through one of Chase’s airline or hotel partners. Take a look at our Chase Sapphire Preferred® Card review to see how. Capital One Venture Rewards Credit Card: The straightforward rewards program could help travelers get value for their purchases without too much extra effort. Check out our Capital One Venture Rewards Credit Card review to learn more. Best rewards credit cards The best rewards credit cards reward you for everyday purchases. Blue Cash Preferred® Card from American Express: Regular grocery shoppers will get plenty of opportunities to earn extra cash back. Learn more about Blue Cash Preferred® Card from American Express to see if this card might make sense for you. Capital One Venture Rewards Credit Card: You’ll get a steady rewards rate on every purchase and a straightforward redemption process for travel. Learn more in our Capital One Venture Rewards Credit Card review. Best low-interest credit cards These best credit cards with 0% intro APR offers are good for people who run into unexpected expenses or need to finance a major purchase. BankAmericard® credit card: This card features a lengthy, useful interest offer. Take a look at our review of BankAmericard® credit card to learn more. Citi Simplicity® Card: This card also gives you a strong intro offer to pay off your new purchases. Find out how in our Citi Simplicity® Card review. U.S. Bank Visa® Platinum Card: You could maximize the time you have to pay back new purchases without being charged interest. See how in our review of the U.S. Bank Visa® Platinum Card. Best balance transfer credit cards The best balance transfer cards offer options and flexibility to people trying to pay off credit card debt. Citi® Diamond Preferred® Card: This card provides more time to transfer your balances after approval. Learn more in our Citi® Diamond Preferred® Card review. Citi Simplicity® Card: This card offers time to pay off your balance — and it has no penalty interest rates. Take a look at our review of Citi Simplicity® Card to learn more. U.S. Bank Visa® Platinum Card: This card could be a great option if you’re looking for extra time to pay off your balance. Check out our review of U.S. Bank Visa® Platinum Card to learn more. Best credit cards for building credit The best credit cards for building credit give people with limited credit histories the opportunity to raise their scores. Discover it® Secured Credit Card: You’ll need to pay a security deposit, but this card offers rewards and the chance to graduate to an unsecured card. Learn more about Discover it® Secured Credit Card. Petal® 1 Visa® Credit Card: You’ll get a chance to build credit without being charged an annual fee or security deposit. Read Petal® 1 Visa® Credit Card member reviews for more takes. Petal® 2 Visa® Credit Card: You’ll have the opportunity to earn quality rewards while you build credit. Take a look at our Petal® 2 Visa® Credit Card review to learn more. Best secured credit cards The best secured credit cards give people access to credit when they might not be able to qualify for other cards. Citi® Secured Mastercard®: This card lets you track your progress as you build credit with access to a free FICO score. Check out our review of Citi® Secured Mastercard® to learn more. Discover it® Secured Credit Card: You could earn rewards while building credit. Read more about Discover it® Secured Credit Card. Capital One Platinum Secured Credit Card: You can build credit, and you might qualify to pay a security deposit that could be lower than your credit line. Take a look at our Capital One Platinum Secured Credit Card review to learn more. Best student credit cards The best student credit cards give students a head start on building credit. Bank of America® Travel Rewards credit card for Students: You could build credit and earn rewards to use while studying abroad or taking a spring break trip. Find out more in our Bank of America® Travel Rewards credit card for Students review. Discover it® Student Cash Back: You could build credit and earn rewards. See what others think about this card by reading member reviews of Discover it® Student Cash Back. How to pick the best credit card for you Picking the best credit card depends on where you are in your credit journey. Take a look at each of these scenarios to see which type of card suits your needs best. Do you want to build credit? If you’re new to credit or you’re trying to bounce back from previous financial mishaps, your top priority should probably be to build credit. Unfortunately, the credit cards with the most rewards and lowest interest rates might not be available to you just yet. But you can still find and apply for cards that you may be more likely to get approved for. That can help give you a better chance of avoiding the hard credit inquiry that comes with applying for a card and then being rejected. Consider a secured card or an unsecured card meant to build credit. These options can help you build credit as long as you pay off your statement balance in full by the due date. Just make sure the card issuer reports your payments to the three major consumer credit bureaus. Do you want to finance a big purchase or pay off debt? If you think you might need to carry a balance or finance a major purchase, you might want to look for a card with a low purchase APR. A card with an introductory 0% APR offer on purchases could be a good way to save money on interest.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> What would you recommend as the top 3 best credit cards if I travel a lot, don't eat at restaurants and don't want to pay any annual fees? <TEXT> Best no-annual-fee credit cards The best credit cards with no annual fee give people a chance to earn rewards and build credit without breaking the bank. Chase Freedom Flex℠: With no annual fee, you won’t have to pay for bonus cash back. Find out what others think in member reviews of Chase Freedom Flex℠. Chase Freedom Unlimited®: For a card with no annual fee, you could earn quite a bit of cash back for your everyday purchases. Take a look at our review of Chase Freedom Unlimited® to see how. Citi Double Cash® Card: You’ll earn cash back at a high rate overall without paying an annual fee. Learn more in our review of the Citi Double Cash® Card. Best cash back credit cards The best cash back credit cards offer reward categories that fit your spending habits. Chase Freedom Flex℠: You can maximize your cash back in a new bonus category every quarter. Check out reviews to see what members think of Chase Freedom Flex℠ and learn more about the current bonus categories. Chase Freedom Unlimited®: This card is worth a look if you want a high rewards rate on everyday purchases and several bonus categories. Take a look at our Chase Freedom Unlimited® review to learn more. Citi Double Cash® Card: This card makes earning cash back simple with a flat rate on all purchases. Find out more in our review of Citi Double Cash® Card. Best travel credit cards The best travel credit cards could help you save up for a future vacation. Bank of America® Premium Rewards® credit card: Quality rewards and several valuable perks give this card a nice value for the annual fee. Find out what sets this card apart in our review of the Bank of America® Premium Rewards® credit card. Chase Sapphire Preferred® Card: The flexible travel rewards could help you book your next vacation through one of Chase’s airline or hotel partners. Take a look at our Chase Sapphire Preferred® Card review to see how. Capital One Venture Rewards Credit Card: The straightforward rewards program could help travelers get value for their purchases without too much extra effort. Check out our Capital One Venture Rewards Credit Card review to learn more. Best rewards credit cards The best rewards credit cards reward you for everyday purchases. Blue Cash Preferred® Card from American Express: Regular grocery shoppers will get plenty of opportunities to earn extra cash back. Learn more about Blue Cash Preferred® Card from American Express to see if this card might make sense for you. Capital One Venture Rewards Credit Card: You’ll get a steady rewards rate on every purchase and a straightforward redemption process for travel. Learn more in our Capital One Venture Rewards Credit Card review. Best low-interest credit cards These best credit cards with 0% intro APR offers are good for people who run into unexpected expenses or need to finance a major purchase. BankAmericard® credit card: This card features a lengthy, useful interest offer. Take a look at our review of BankAmericard® credit card to learn more. Citi Simplicity® Card: This card also gives you a strong intro offer to pay off your new purchases. Find out how in our Citi Simplicity® Card review. U.S. Bank Visa® Platinum Card: You could maximize the time you have to pay back new purchases without being charged interest. See how in our review of the U.S. Bank Visa® Platinum Card. Best balance transfer credit cards The best balance transfer cards offer options and flexibility to people trying to pay off credit card debt. Citi® Diamond Preferred® Card: This card provides more time to transfer your balances after approval. Learn more in our Citi® Diamond Preferred® Card review. Citi Simplicity® Card: This card offers time to pay off your balance — and it has no penalty interest rates. Take a look at our review of Citi Simplicity® Card to learn more. U.S. Bank Visa® Platinum Card: This card could be a great option if you’re looking for extra time to pay off your balance. Check out our review of U.S. Bank Visa® Platinum Card to learn more. Best credit cards for building credit The best credit cards for building credit give people with limited credit histories the opportunity to raise their scores. Discover it® Secured Credit Card: You’ll need to pay a security deposit, but this card offers rewards and the chance to graduate to an unsecured card. Learn more about Discover it® Secured Credit Card. Petal® 1 Visa® Credit Card: You’ll get a chance to build credit without being charged an annual fee or security deposit. Read Petal® 1 Visa® Credit Card member reviews for more takes. Petal® 2 Visa® Credit Card: You’ll have the opportunity to earn quality rewards while you build credit. Take a look at our Petal® 2 Visa® Credit Card review to learn more. Best secured credit cards The best secured credit cards give people access to credit when they might not be able to qualify for other cards. Citi® Secured Mastercard®: This card lets you track your progress as you build credit with access to a free FICO score. Check out our review of Citi® Secured Mastercard® to learn more. Discover it® Secured Credit Card: You could earn rewards while building credit. Read more about Discover it® Secured Credit Card. Capital One Platinum Secured Credit Card: You can build credit, and you might qualify to pay a security deposit that could be lower than your credit line. Take a look at our Capital One Platinum Secured Credit Card review to learn more. Best student credit cards The best student credit cards give students a head start on building credit. Bank of America® Travel Rewards credit card for Students: You could build credit and earn rewards to use while studying abroad or taking a spring break trip. Find out more in our Bank of America® Travel Rewards credit card for Students review. Discover it® Student Cash Back: You could build credit and earn rewards. See what others think about this card by reading member reviews of Discover it® Student Cash Back. How to pick the best credit card for you Picking the best credit card depends on where you are in your credit journey. Take a look at each of these scenarios to see which type of card suits your needs best. Do you want to build credit? If you’re new to credit or you’re trying to bounce back from previous financial mishaps, your top priority should probably be to build credit. Unfortunately, the credit cards with the most rewards and lowest interest rates might not be available to you just yet. But you can still find and apply for cards that you may be more likely to get approved for. That can help give you a better chance of avoiding the hard credit inquiry that comes with applying for a card and then being rejected. Consider a secured card or an unsecured card meant to build credit. These options can help you build credit as long as you pay off your statement balance in full by the due date. Just make sure the card issuer reports your payments to the three major consumer credit bureaus. Do you want to finance a big purchase or pay off debt? If you think you might need to carry a balance or finance a major purchase, you might want to look for a card with a low purchase APR. A card with an introductory 0% APR offer on purchases could be a good way to save money on interest. https://www.creditkarma.com/credit-cards#best-no-annual-fee-credit-cards
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
Best no-annual-fee credit cards The best credit cards with no annual fee give people a chance to earn rewards and build credit without breaking the bank. Chase Freedom Flex℠: With no annual fee, you won’t have to pay for bonus cash back. Find out what others think in member reviews of Chase Freedom Flex℠. Chase Freedom Unlimited®: For a card with no annual fee, you could earn quite a bit of cash back for your everyday purchases. Take a look at our review of Chase Freedom Unlimited® to see how. Citi Double Cash® Card: You’ll earn cash back at a high rate overall without paying an annual fee. Learn more in our review of the Citi Double Cash® Card. Best cash back credit cards The best cash back credit cards offer reward categories that fit your spending habits. Chase Freedom Flex℠: You can maximize your cash back in a new bonus category every quarter. Check out reviews to see what members think of Chase Freedom Flex℠ and learn more about the current bonus categories. Chase Freedom Unlimited®: This card is worth a look if you want a high rewards rate on everyday purchases and several bonus categories. Take a look at our Chase Freedom Unlimited® review to learn more. Citi Double Cash® Card: This card makes earning cash back simple with a flat rate on all purchases. Find out more in our review of Citi Double Cash® Card. Best travel credit cards The best travel credit cards could help you save up for a future vacation. Bank of America® Premium Rewards® credit card: Quality rewards and several valuable perks give this card a nice value for the annual fee. Find out what sets this card apart in our review of the Bank of America® Premium Rewards® credit card. Chase Sapphire Preferred® Card: The flexible travel rewards could help you book your next vacation through one of Chase’s airline or hotel partners. Take a look at our Chase Sapphire Preferred® Card review to see how. Capital One Venture Rewards Credit Card: The straightforward rewards program could help travelers get value for their purchases without too much extra effort. Check out our Capital One Venture Rewards Credit Card review to learn more. Best rewards credit cards The best rewards credit cards reward you for everyday purchases. Blue Cash Preferred® Card from American Express: Regular grocery shoppers will get plenty of opportunities to earn extra cash back. Learn more about Blue Cash Preferred® Card from American Express to see if this card might make sense for you. Capital One Venture Rewards Credit Card: You’ll get a steady rewards rate on every purchase and a straightforward redemption process for travel. Learn more in our Capital One Venture Rewards Credit Card review. Best low-interest credit cards These best credit cards with 0% intro APR offers are good for people who run into unexpected expenses or need to finance a major purchase. BankAmericard® credit card: This card features a lengthy, useful interest offer. Take a look at our review of BankAmericard® credit card to learn more. Citi Simplicity® Card: This card also gives you a strong intro offer to pay off your new purchases. Find out how in our Citi Simplicity® Card review. U.S. Bank Visa® Platinum Card: You could maximize the time you have to pay back new purchases without being charged interest. See how in our review of the U.S. Bank Visa® Platinum Card. Best balance transfer credit cards The best balance transfer cards offer options and flexibility to people trying to pay off credit card debt. Citi® Diamond Preferred® Card: This card provides more time to transfer your balances after approval. Learn more in our Citi® Diamond Preferred® Card review. Citi Simplicity® Card: This card offers time to pay off your balance — and it has no penalty interest rates. Take a look at our review of Citi Simplicity® Card to learn more. U.S. Bank Visa® Platinum Card: This card could be a great option if you’re looking for extra time to pay off your balance. Check out our review of U.S. Bank Visa® Platinum Card to learn more. Best credit cards for building credit The best credit cards for building credit give people with limited credit histories the opportunity to raise their scores. Discover it® Secured Credit Card: You’ll need to pay a security deposit, but this card offers rewards and the chance to graduate to an unsecured card. Learn more about Discover it® Secured Credit Card. Petal® 1 Visa® Credit Card: You’ll get a chance to build credit without being charged an annual fee or security deposit. Read Petal® 1 Visa® Credit Card member reviews for more takes. Petal® 2 Visa® Credit Card: You’ll have the opportunity to earn quality rewards while you build credit. Take a look at our Petal® 2 Visa® Credit Card review to learn more. Best secured credit cards The best secured credit cards give people access to credit when they might not be able to qualify for other cards. Citi® Secured Mastercard®: This card lets you track your progress as you build credit with access to a free FICO score. Check out our review of Citi® Secured Mastercard® to learn more. Discover it® Secured Credit Card: You could earn rewards while building credit. Read more about Discover it® Secured Credit Card. Capital One Platinum Secured Credit Card: You can build credit, and you might qualify to pay a security deposit that could be lower than your credit line. Take a look at our Capital One Platinum Secured Credit Card review to learn more. Best student credit cards The best student credit cards give students a head start on building credit. Bank of America® Travel Rewards credit card for Students: You could build credit and earn rewards to use while studying abroad or taking a spring break trip. Find out more in our Bank of America® Travel Rewards credit card for Students review. Discover it® Student Cash Back: You could build credit and earn rewards. See what others think about this card by reading member reviews of Discover it® Student Cash Back. How to pick the best credit card for you Picking the best credit card depends on where you are in your credit journey. Take a look at each of these scenarios to see which type of card suits your needs best. Do you want to build credit? If you’re new to credit or you’re trying to bounce back from previous financial mishaps, your top priority should probably be to build credit. Unfortunately, the credit cards with the most rewards and lowest interest rates might not be available to you just yet. But you can still find and apply for cards that you may be more likely to get approved for. That can help give you a better chance of avoiding the hard credit inquiry that comes with applying for a card and then being rejected. Consider a secured card or an unsecured card meant to build credit. These options can help you build credit as long as you pay off your statement balance in full by the due date. Just make sure the card issuer reports your payments to the three major consumer credit bureaus. Do you want to finance a big purchase or pay off debt? If you think you might need to carry a balance or finance a major purchase, you might want to look for a card with a low purchase APR. A card with an introductory 0% APR offer on purchases could be a good way to save money on interest.
USER:
What would you recommend as the top 3 best credit cards if I travel a lot, don't eat at restaurants and don't want to pay any annual fees?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 28 | 1,260 | null | 733 |
The following prompt requires you to answer solely using the information found within the context block. Do not use any additional external information or prior knowledge to aid your response. Focus on the technological aspects rather than providing general information. Use as much of the context block as possible to fully answer the prompt. Keep the response easy-to-digest bullet points, expanding where necessary to provide essential context. Use simplified language that all ages can understand.
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Summarise the stages of compiling and processing 3D graphics
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3D Pipeline 2.4.1.2.1 Vertex Fetch (VF) Stage The VF stage executes 3DPRIMITIVE commands. Some enhancements have been included to better support legacy D3D APIs as well as SGI OpenGL*. 2.4.1.2.2 Vertex Shader (VS) Stage The VS stage performs shading of vertices output by the VF function. The VS unit produces an output vertex reference for every input vertex reference received from the VF unit, in the order received. Figure 7. Integrated Graphics Controller Unit Block Diagram Plane A Cursor B Sprite B Plane B Cursor A Sprite A Pipe B Pipe A Memory M U X VGA Video Engine 2D Engine 3D Engine Clipper Strip & Fan/Setup Alpha Blend/ Gamma /Panel Fitter Geometry Shader Vertex Fetch/Vertex Shader Windower/IZ Intel® FDI eDP Datasheet 29 Interfaces 2.4.1.2.3 Geometry Shader (GS) Stage The GS stage receives inputs from the VS stage. Compiled application-provided GS programs, specifying an algorithm to convert the vertices of an input object into some output primitives. For example, a GS shader may convert lines of a line strip into polygons representing a corresponding segment of a blade of grass centered on the line. Or it could use adjacency information to detect silhouette edges of triangles and output polygons extruding out from the edges. 2.4.1.2.4 Clip Stage The Clip stage performs general processing on incoming 3D objects. However, it also includes specialized logic to perform a Clip Test function on incoming objects. The Clip Test optimizes generalized 3D Clipping. The Clip unit examines the position of incoming vertices, and accepts/rejects 3D objects based on its Clip algorithm. 2.4.1.2.5 Strips and Fans (SF) Stage The SF stage performs setup operations required to rasterize 3D objects. The outputs from the SF stage to the Windower stage contain implementation-specific information required for the rasterization of objects and also supports clipping of primitives to some extent. 2.4.1.2.6 Windower/IZ (WIZ) Stage The WIZ unit performs an early depth test, which removes failing pixels and eliminates unnecessary processing overhead. The Windower uses the parameters provided by the SF unit in the object-specific rasterization algorithms. The WIZ unit rasterizes objects into the corresponding set of pixels. The Windower is also capable of performing dithering, whereby the illusion of a higher resolution when using low-bpp channels in color buffers is possible. Color dithering diffuses the sharp color bands seen on smooth-shaded objects. 2.4.1.3 Video Engine The Video Engine handles the non-3D (media/video) applications. It includes support for VLD and MPEG2 decode in hardware. 2.4.1.4 2D Engine The 2D Engine contains BLT (Block Level Transfer) functionality and an extensive set of 2D instructions. To take advantage of the 3D during engine’s functionality, some BLT functions make use of the 3D renderer. 2.4.1.4.1 Integrated Graphics VGA Registers The 2D registers consists of original VGA registers and others to support graphics modes that have color depths, resolutions, and hardware acceleration features that go beyond the original VGA standard. Interfaces 30 Datasheet 2.4.1.4.2 Logical 128-Bit Fixed BLT and 256 Fill Engine This BLT engine accelerates the GUI of Microsoft Windows* operating systems. The 128-bit BLT engine provides hardware acceleration of block transfers of pixel data for many common Windows operations. The BLT engine can be used for the following: • Move rectangular blocks of data between memory locations • Data alignment • To perform logical operations (raster ops) The rectangular block of data does not change, as it is transferred between memory locations. The allowable memory transfers are between: cacheable system memory and frame buffer memory, frame buffer memory and frame buffer memory, and within system memory. Data to be transferred can consist of regions of memory, patterns, or solid color fills. A pattern is always 8 x 8 pixels wide and may be 8, 16, or 32 bits per pixel. The BLT engine expands monochrome data into a color depth of 8, 16, or 32 bits. BLTs can be either opaque or transparent. Opaque transfers move the data specified to the destination. Transparent transfers compare destination color to source color and write according to the mode of transparency selected. Data is horizontally and vertically aligned at the destination. If the destination for the BLT overlaps with the source memory location, the BLT engine specifies which area in memory to begin the BLT transfer. Hardware is included for all 256 raster operations (source, pattern, and destination) defined by Microsoft, including transparent BLT. The BLT engine has instructions to invoke BLT and stretch BLT operations, permitting software to set up instruction buffers and use batch processing. The BLT engine can perform hardware clipping during BLTs.
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System instruction: The following prompt requires you to answer solely using the information found within the context block. Do not use any additional external information or prior knowledge to aid your response. Focus on the technological aspects rather than providing general information. Use as much of the context block as possible to fully answer the prompt. Keep the response easy-to-digest bullet points, expanding where necessary to provide essential context. Use simplified language that all ages can understand. Question: Summarise the stages of compiling and processing 3D graphics 3D Pipeline 2.4.1.2.1 Vertex Fetch (VF) Stage The VF stage executes 3DPRIMITIVE commands. Some enhancements have been included to better support legacy D3D APIs as well as SGI OpenGL*. 2.4.1.2.2 Vertex Shader (VS) Stage The VS stage performs shading of vertices output by the VF function. The VS unit produces an output vertex reference for every input vertex reference received from the VF unit, in the order received. Figure 7. Integrated Graphics Controller Unit Block Diagram Plane A Cursor B Sprite B Plane B Cursor A Sprite A Pipe B Pipe A Memory M U X VGA Video Engine 2D Engine 3D Engine Clipper Strip & Fan/Setup Alpha Blend/ Gamma /Panel Fitter Geometry Shader Vertex Fetch/Vertex Shader Windower/IZ Intel® FDI eDP Datasheet 29 Interfaces 2.4.1.2.3 Geometry Shader (GS) Stage The GS stage receives inputs from the VS stage. Compiled application-provided GS programs, specifying an algorithm to convert the vertices of an input object into some output primitives. For example, a GS shader may convert lines of a line strip into polygons representing a corresponding segment of a blade of grass centered on the line. Or it could use adjacency information to detect silhouette edges of triangles and output polygons extruding out from the edges. 2.4.1.2.4 Clip Stage The Clip stage performs general processing on incoming 3D objects. However, it also includes specialized logic to perform a Clip Test function on incoming objects. The Clip Test optimizes generalized 3D Clipping. The Clip unit examines the position of incoming vertices, and accepts/rejects 3D objects based on its Clip algorithm. 2.4.1.2.5 Strips and Fans (SF) Stage The SF stage performs setup operations required to rasterize 3D objects. The outputs from the SF stage to the Windower stage contain implementation-specific information required for the rasterization of objects and also supports clipping of primitives to some extent. 2.4.1.2.6 Windower/IZ (WIZ) Stage The WIZ unit performs an early depth test, which removes failing pixels and eliminates unnecessary processing overhead. The Windower uses the parameters provided by the SF unit in the object-specific rasterization algorithms. The WIZ unit rasterizes objects into the corresponding set of pixels. The Windower is also capable of performing dithering, whereby the illusion of a higher resolution when using low-bpp channels in color buffers is possible. Color dithering diffuses the sharp color bands seen on smooth-shaded objects. 2.4.1.3 Video Engine The Video Engine handles the non-3D (media/video) applications. It includes support for VLD and MPEG2 decode in hardware. 2.4.1.4 2D Engine The 2D Engine contains BLT (Block Level Transfer) functionality and an extensive set of 2D instructions. To take advantage of the 3D during engine’s functionality, some BLT functions make use of the 3D renderer. 2.4.1.4.1 Integrated Graphics VGA Registers The 2D registers consists of original VGA registers and others to support graphics modes that have color depths, resolutions, and hardware acceleration features that go beyond the original VGA standard. Interfaces 30 Datasheet 2.4.1.4.2 Logical 128-Bit Fixed BLT and 256 Fill Engine This BLT engine accelerates the GUI of Microsoft Windows* operating systems. The 128-bit BLT engine provides hardware acceleration of block transfers of pixel data for many common Windows operations. The BLT engine can be used for the following: • Move rectangular blocks of data between memory locations • Data alignment • To perform logical operations (raster ops) The rectangular block of data does not change, as it is transferred between memory locations. The allowable memory transfers are between: cacheable system memory and frame buffer memory, frame buffer memory and frame buffer memory, and within system memory. Data to be transferred can consist of regions of memory, patterns, or solid color fills. A pattern is always 8 x 8 pixels wide and may be 8, 16, or 32 bits per pixel. The BLT engine expands monochrome data into a color depth of 8, 16, or 32 bits. BLTs can be either opaque or transparent. Opaque transfers move the data specified to the destination. Transparent transfers compare destination color to source color and write according to the mode of transparency selected. Data is horizontally and vertically aligned at the destination. If the destination for the BLT overlaps with the source memory location, the BLT engine specifies which area in memory to begin the BLT transfer. Hardware is included for all 256 raster operations (source, pattern, and destination) defined by Microsoft, including transparent BLT. The BLT engine has instructions to invoke BLT and stretch BLT operations, permitting software to set up instruction buffers and use batch processing. The BLT engine can perform hardware clipping during BLTs.
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The following prompt requires you to answer solely using the information found within the context block. Do not use any additional external information or prior knowledge to aid your response. Focus on the technological aspects rather than providing general information. Use as much of the context block as possible to fully answer the prompt. Keep the response easy-to-digest bullet points, expanding where necessary to provide essential context. Use simplified language that all ages can understand.
EVIDENCE:
3D Pipeline 2.4.1.2.1 Vertex Fetch (VF) Stage The VF stage executes 3DPRIMITIVE commands. Some enhancements have been included to better support legacy D3D APIs as well as SGI OpenGL*. 2.4.1.2.2 Vertex Shader (VS) Stage The VS stage performs shading of vertices output by the VF function. The VS unit produces an output vertex reference for every input vertex reference received from the VF unit, in the order received. Figure 7. Integrated Graphics Controller Unit Block Diagram Plane A Cursor B Sprite B Plane B Cursor A Sprite A Pipe B Pipe A Memory M U X VGA Video Engine 2D Engine 3D Engine Clipper Strip & Fan/Setup Alpha Blend/ Gamma /Panel Fitter Geometry Shader Vertex Fetch/Vertex Shader Windower/IZ Intel® FDI eDP Datasheet 29 Interfaces 2.4.1.2.3 Geometry Shader (GS) Stage The GS stage receives inputs from the VS stage. Compiled application-provided GS programs, specifying an algorithm to convert the vertices of an input object into some output primitives. For example, a GS shader may convert lines of a line strip into polygons representing a corresponding segment of a blade of grass centered on the line. Or it could use adjacency information to detect silhouette edges of triangles and output polygons extruding out from the edges. 2.4.1.2.4 Clip Stage The Clip stage performs general processing on incoming 3D objects. However, it also includes specialized logic to perform a Clip Test function on incoming objects. The Clip Test optimizes generalized 3D Clipping. The Clip unit examines the position of incoming vertices, and accepts/rejects 3D objects based on its Clip algorithm. 2.4.1.2.5 Strips and Fans (SF) Stage The SF stage performs setup operations required to rasterize 3D objects. The outputs from the SF stage to the Windower stage contain implementation-specific information required for the rasterization of objects and also supports clipping of primitives to some extent. 2.4.1.2.6 Windower/IZ (WIZ) Stage The WIZ unit performs an early depth test, which removes failing pixels and eliminates unnecessary processing overhead. The Windower uses the parameters provided by the SF unit in the object-specific rasterization algorithms. The WIZ unit rasterizes objects into the corresponding set of pixels. The Windower is also capable of performing dithering, whereby the illusion of a higher resolution when using low-bpp channels in color buffers is possible. Color dithering diffuses the sharp color bands seen on smooth-shaded objects. 2.4.1.3 Video Engine The Video Engine handles the non-3D (media/video) applications. It includes support for VLD and MPEG2 decode in hardware. 2.4.1.4 2D Engine The 2D Engine contains BLT (Block Level Transfer) functionality and an extensive set of 2D instructions. To take advantage of the 3D during engine’s functionality, some BLT functions make use of the 3D renderer. 2.4.1.4.1 Integrated Graphics VGA Registers The 2D registers consists of original VGA registers and others to support graphics modes that have color depths, resolutions, and hardware acceleration features that go beyond the original VGA standard. Interfaces 30 Datasheet 2.4.1.4.2 Logical 128-Bit Fixed BLT and 256 Fill Engine This BLT engine accelerates the GUI of Microsoft Windows* operating systems. The 128-bit BLT engine provides hardware acceleration of block transfers of pixel data for many common Windows operations. The BLT engine can be used for the following: • Move rectangular blocks of data between memory locations • Data alignment • To perform logical operations (raster ops) The rectangular block of data does not change, as it is transferred between memory locations. The allowable memory transfers are between: cacheable system memory and frame buffer memory, frame buffer memory and frame buffer memory, and within system memory. Data to be transferred can consist of regions of memory, patterns, or solid color fills. A pattern is always 8 x 8 pixels wide and may be 8, 16, or 32 bits per pixel. The BLT engine expands monochrome data into a color depth of 8, 16, or 32 bits. BLTs can be either opaque or transparent. Opaque transfers move the data specified to the destination. Transparent transfers compare destination color to source color and write according to the mode of transparency selected. Data is horizontally and vertically aligned at the destination. If the destination for the BLT overlaps with the source memory location, the BLT engine specifies which area in memory to begin the BLT transfer. Hardware is included for all 256 raster operations (source, pattern, and destination) defined by Microsoft, including transparent BLT. The BLT engine has instructions to invoke BLT and stretch BLT operations, permitting software to set up instruction buffers and use batch processing. The BLT engine can perform hardware clipping during BLTs.
USER:
Summarise the stages of compiling and processing 3D graphics
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 75 | 9 | 752 | null | 472 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
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Please summarize all of the major points in this article. Describe and explain the differences between the various protocols. Make sure to define them in relation to each other and the concepts discussed in the article so I can understand them better.
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Point-to-Point Generic Routing Encapsulation over IP Security Generic Routing Encapsulation (GRE) is a widely used encapsulation protocol in computer networking. It allows the transmission of diverse network protocols over an IP network infrastructure. In this blog post, we'll delve into the details of the GRE and its significance in modern networking. GRE acts as a tunneling protocol, encapsulating packets from one network protocol within another. By creating a virtual point-to-point link, it facilitates the transmission of data across different network domains. This enables the interconnection of disparate networks, making GRE a crucial tool for securely building virtual private networks (VPNs) and connecting remote sites. P2P GRE is a tunneling protocol that allows the encapsulation of various network layer protocols within IP packets. It provides a secure and reliable method of transmitting data between two points in a network. By encapsulating packets in IP headers, P2P GRE ensures data integrity and confidentiality. IP Security (IPsec) plays a crucial role in enhancing the security of P2P GRE tunnels. By leveraging cryptographic algorithms, IPsec provides authentication, integrity, and confidentiality of data transmitted over the network. It establishes a secure channel between two endpoints, ensuring that data remains protected from unauthorized access and tampering. Enhanced Network Security: P2P GRE over IP Security offers a robust security solution for organizations by providing secure communication channels across public and private networks. It allows for the establishment of secure connections between geographically dispersed locations, ensuring the confidentiality of sensitive data. Improved Network Performance: P2P GRE over IP Security optimizes network performance by encapsulating and routing packets efficiently. It enables the transmission of data across different network topologies, reducing network congestion and enhancing overall network efficiency. Seamless Integration with Existing Infrastructures: One of the key advantages of P2P GRE over IP Security is its compatibility with existing network infrastructures. It can be seamlessly integrated into existing networks without the need for significant architectural changes, making it a cost-effective solution for organizations. Security Measures: Implementing P2P GRE over IP Security requires careful consideration of security measures. Organizations should ensure that strong encryption algorithms are utilized, proper key management practices are in place, and regular security audits are conducted to maintain the integrity of the network. Scalability and Performance Optimization: To ensure optimal performance, network administrators should carefully plan and configure the P2P GRE tunnels. Factors such as bandwidth allocation, traffic prioritization, and Quality of Service (QoS) settings should be taken into account to guarantee the efficient operation of the network. Generic Tunnelling Understanding P2P GRE & IPSec P2P GRE is a tunneling protocol that allows the encapsulation of different network protocols within an IP network. It provides a secure and efficient mechanism for transmitting data between two network endpoints. By encapsulating packets, P2P GRE ensures that information is protected from external threats and remains intact during transmission. IPsec, on the other hand, is a suite of protocols that provides security services at the IP layer. It offers authentication, confidentiality, and integrity to IP packets, ensuring that data remains secure even when traversing untrusted networks. IPsec can be combined with P2P GRE to create a robust and secure communication channel. The combination of P2P GRE and IPsec brings several benefits to network administrators and organizations. Firstly, it enables secure communication between geographically dispersed networks, allowing for seamless connectivity. Additionally, P2P GRE over IPsec provides strong encryption, ensuring the confidentiality of sensitive data. It also allows for the creation of virtual private networks (VPNs), offering a secure and private network environment. P2P GRE over IPsec finds applications in various scenarios. One common use case is connecting branch offices of an organization securely. By establishing a P2P GRE over IPsec tunnel between different locations, organizations can create a secure network environment for their remote sites. Another use case is securely connecting cloud resources to on-premises infrastructure, enabling secure and seamless integration. The role of GRE: In GRE, packets are wrapped within other packets that use supported protocols, allowing the use of protocols not generally supported by a network. To understand this, consider the difference between a car and a ferry. On land, cars travel on roads, while ferries travel on water. Usually, cars cannot travel on water but can be loaded onto ferries. In this analogy, terrain could be compared to a network that supports specific routing protocols and vehicles to data packets. Similarly, one type of vehicle (the car) is loaded onto a different kind of vehicle (the ferry) to cross terrain it could not otherwise. GRE tunneling: how does it work? GRE tunnels encapsulate packets within other packets. Each router represents the end of the tunnel. GRE packets are exchanged directly between routers. When routers are between forwarding packets, they use headers surrounding them rather than opening the encapsulated packets. Every packet of data sent over a network has the payload and the header. The payload contains the data being sent, while the headers contain information about the source and group of the packet. Each network protocol attaches a header to each packet. Unlike load limits on automobile bridges, data packet sizes are limited by MTU and MSS. An MSS measurement only measures a packet’s payload, not its headers. Including the headers, the MTU measures the total size of a packet. Packets that exceed MTU are fragmented to fit through the network. GRE configuration GRE Operation GRE is a layer three protocol, meaning it works at the IP level of the network. It enables a router to encapsulate packets of a particular protocol and send them to another router, where they are decapsulated and forwarded to their destination. This is useful for tunneling, where data must traverse multiple networks and different types of hardware. GRE encapsulates data in a header containing information about the source, destination, and other routing information. The GRE header is then encapsulated in an IP header containing the source and destination IP addresses. When the packet reaches the destination router, the GRE header is stripped off, and the data is sent to its destination. GRE over IPsec Understanding Multipoint GRE Multipoint GRE, or mGRE, is a tunneling protocol for encapsulating packets and transmitting them over an IP network. It enables virtual point-to-multipoint connections, allowing multiple endpoints to communicate simultaneously. By utilizing a single tunnel interface, mGRE simplifies network configurations and optimizes resource utilization. One of Multipoint GRE’s standout features is its ability to transport multicast and broadcast traffic across multiple sites efficiently. It achieves this through a single tunnel interface, eliminating the need for dedicated point-to-point connections. This scalability and flexibility make mGRE an excellent choice for large-scale deployments and multicast applications. DMVPN, as the name suggests, is a virtual private network technology that dynamically creates VPN connections between multiple sites without needing dedicated point-to-point links. It utilizes a hub-and-spoke architecture, with the hub as the central point for all communication. Using the Next Hop Resolution Protocol (NHRP), DMVPN provides a highly scalable and flexible solution for securely interconnecting sites. Multipoint GRE, or mGRE, is a tunneling protocol my DMVPN uses to create point-to-multipoint connections. It allows multiple spokes to communicate directly with each other, bypassing the hub. By encapsulating packets within GRE headers, mGRE establishes virtual links between spokes, providing a flexible and efficient method of data transmission.
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Please summarize all of the major points in this article. Describe and explain the differences between the various protocols. Make sure to define them in relation to each other and the concepts discussed in the article so I can understand them better. {passage 0} ========== Point-to-Point Generic Routing Encapsulation over IP Security Generic Routing Encapsulation (GRE) is a widely used encapsulation protocol in computer networking. It allows the transmission of diverse network protocols over an IP network infrastructure. In this blog post, we'll delve into the details of the GRE and its significance in modern networking. GRE acts as a tunneling protocol, encapsulating packets from one network protocol within another. By creating a virtual point-to-point link, it facilitates the transmission of data across different network domains. This enables the interconnection of disparate networks, making GRE a crucial tool for securely building virtual private networks (VPNs) and connecting remote sites. P2P GRE is a tunneling protocol that allows the encapsulation of various network layer protocols within IP packets. It provides a secure and reliable method of transmitting data between two points in a network. By encapsulating packets in IP headers, P2P GRE ensures data integrity and confidentiality. IP Security (IPsec) plays a crucial role in enhancing the security of P2P GRE tunnels. By leveraging cryptographic algorithms, IPsec provides authentication, integrity, and confidentiality of data transmitted over the network. It establishes a secure channel between two endpoints, ensuring that data remains protected from unauthorized access and tampering. Enhanced Network Security: P2P GRE over IP Security offers a robust security solution for organizations by providing secure communication channels across public and private networks. It allows for the establishment of secure connections between geographically dispersed locations, ensuring the confidentiality of sensitive data. Improved Network Performance: P2P GRE over IP Security optimizes network performance by encapsulating and routing packets efficiently. It enables the transmission of data across different network topologies, reducing network congestion and enhancing overall network efficiency. Seamless Integration with Existing Infrastructures: One of the key advantages of P2P GRE over IP Security is its compatibility with existing network infrastructures. It can be seamlessly integrated into existing networks without the need for significant architectural changes, making it a cost-effective solution for organizations. Security Measures: Implementing P2P GRE over IP Security requires careful consideration of security measures. Organizations should ensure that strong encryption algorithms are utilized, proper key management practices are in place, and regular security audits are conducted to maintain the integrity of the network. Scalability and Performance Optimization: To ensure optimal performance, network administrators should carefully plan and configure the P2P GRE tunnels. Factors such as bandwidth allocation, traffic prioritization, and Quality of Service (QoS) settings should be taken into account to guarantee the efficient operation of the network. Generic Tunnelling Understanding P2P GRE & IPSec P2P GRE is a tunneling protocol that allows the encapsulation of different network protocols within an IP network. It provides a secure and efficient mechanism for transmitting data between two network endpoints. By encapsulating packets, P2P GRE ensures that information is protected from external threats and remains intact during transmission. IPsec, on the other hand, is a suite of protocols that provides security services at the IP layer. It offers authentication, confidentiality, and integrity to IP packets, ensuring that data remains secure even when traversing untrusted networks. IPsec can be combined with P2P GRE to create a robust and secure communication channel. The combination of P2P GRE and IPsec brings several benefits to network administrators and organizations. Firstly, it enables secure communication between geographically dispersed networks, allowing for seamless connectivity. Additionally, P2P GRE over IPsec provides strong encryption, ensuring the confidentiality of sensitive data. It also allows for the creation of virtual private networks (VPNs), offering a secure and private network environment. P2P GRE over IPsec finds applications in various scenarios. One common use case is connecting branch offices of an organization securely. By establishing a P2P GRE over IPsec tunnel between different locations, organizations can create a secure network environment for their remote sites. Another use case is securely connecting cloud resources to on-premises infrastructure, enabling secure and seamless integration. The role of GRE: In GRE, packets are wrapped within other packets that use supported protocols, allowing the use of protocols not generally supported by a network. To understand this, consider the difference between a car and a ferry. On land, cars travel on roads, while ferries travel on water. Usually, cars cannot travel on water but can be loaded onto ferries. In this analogy, terrain could be compared to a network that supports specific routing protocols and vehicles to data packets. Similarly, one type of vehicle (the car) is loaded onto a different kind of vehicle (the ferry) to cross terrain it could not otherwise. GRE tunneling: how does it work? GRE tunnels encapsulate packets within other packets. Each router represents the end of the tunnel. GRE packets are exchanged directly between routers. When routers are between forwarding packets, they use headers surrounding them rather than opening the encapsulated packets. Every packet of data sent over a network has the payload and the header. The payload contains the data being sent, while the headers contain information about the source and group of the packet. Each network protocol attaches a header to each packet. Unlike load limits on automobile bridges, data packet sizes are limited by MTU and MSS. An MSS measurement only measures a packet’s payload, not its headers. Including the headers, the MTU measures the total size of a packet. Packets that exceed MTU are fragmented to fit through the network. GRE configuration GRE Operation GRE is a layer three protocol, meaning it works at the IP level of the network. It enables a router to encapsulate packets of a particular protocol and send them to another router, where they are decapsulated and forwarded to their destination. This is useful for tunneling, where data must traverse multiple networks and different types of hardware. GRE encapsulates data in a header containing information about the source, destination, and other routing information. The GRE header is then encapsulated in an IP header containing the source and destination IP addresses. When the packet reaches the destination router, the GRE header is stripped off, and the data is sent to its destination. GRE over IPsec Understanding Multipoint GRE Multipoint GRE, or mGRE, is a tunneling protocol for encapsulating packets and transmitting them over an IP network. It enables virtual point-to-multipoint connections, allowing multiple endpoints to communicate simultaneously. By utilizing a single tunnel interface, mGRE simplifies network configurations and optimizes resource utilization. One of Multipoint GRE’s standout features is its ability to transport multicast and broadcast traffic across multiple sites efficiently. It achieves this through a single tunnel interface, eliminating the need for dedicated point-to-point connections. This scalability and flexibility make mGRE an excellent choice for large-scale deployments and multicast applications. DMVPN, as the name suggests, is a virtual private network technology that dynamically creates VPN connections between multiple sites without needing dedicated point-to-point links. It utilizes a hub-and-spoke architecture, with the hub as the central point for all communication. Using the Next Hop Resolution Protocol (NHRP), DMVPN provides a highly scalable and flexible solution for securely interconnecting sites. Multipoint GRE, or mGRE, is a tunneling protocol my DMVPN uses to create point-to-multipoint connections. It allows multiple spokes to communicate directly with each other, bypassing the hub. By encapsulating packets within GRE headers, mGRE establishes virtual links between spokes, providing a flexible and efficient method of data transmission. https://network-insight.net/2014/12/15/point-to-point-generic-routing-encapsulation-gre-over-ip-security-ipsec/
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
Point-to-Point Generic Routing Encapsulation over IP Security Generic Routing Encapsulation (GRE) is a widely used encapsulation protocol in computer networking. It allows the transmission of diverse network protocols over an IP network infrastructure. In this blog post, we'll delve into the details of the GRE and its significance in modern networking. GRE acts as a tunneling protocol, encapsulating packets from one network protocol within another. By creating a virtual point-to-point link, it facilitates the transmission of data across different network domains. This enables the interconnection of disparate networks, making GRE a crucial tool for securely building virtual private networks (VPNs) and connecting remote sites. P2P GRE is a tunneling protocol that allows the encapsulation of various network layer protocols within IP packets. It provides a secure and reliable method of transmitting data between two points in a network. By encapsulating packets in IP headers, P2P GRE ensures data integrity and confidentiality. IP Security (IPsec) plays a crucial role in enhancing the security of P2P GRE tunnels. By leveraging cryptographic algorithms, IPsec provides authentication, integrity, and confidentiality of data transmitted over the network. It establishes a secure channel between two endpoints, ensuring that data remains protected from unauthorized access and tampering. Enhanced Network Security: P2P GRE over IP Security offers a robust security solution for organizations by providing secure communication channels across public and private networks. It allows for the establishment of secure connections between geographically dispersed locations, ensuring the confidentiality of sensitive data. Improved Network Performance: P2P GRE over IP Security optimizes network performance by encapsulating and routing packets efficiently. It enables the transmission of data across different network topologies, reducing network congestion and enhancing overall network efficiency. Seamless Integration with Existing Infrastructures: One of the key advantages of P2P GRE over IP Security is its compatibility with existing network infrastructures. It can be seamlessly integrated into existing networks without the need for significant architectural changes, making it a cost-effective solution for organizations. Security Measures: Implementing P2P GRE over IP Security requires careful consideration of security measures. Organizations should ensure that strong encryption algorithms are utilized, proper key management practices are in place, and regular security audits are conducted to maintain the integrity of the network. Scalability and Performance Optimization: To ensure optimal performance, network administrators should carefully plan and configure the P2P GRE tunnels. Factors such as bandwidth allocation, traffic prioritization, and Quality of Service (QoS) settings should be taken into account to guarantee the efficient operation of the network. Generic Tunnelling Understanding P2P GRE & IPSec P2P GRE is a tunneling protocol that allows the encapsulation of different network protocols within an IP network. It provides a secure and efficient mechanism for transmitting data between two network endpoints. By encapsulating packets, P2P GRE ensures that information is protected from external threats and remains intact during transmission. IPsec, on the other hand, is a suite of protocols that provides security services at the IP layer. It offers authentication, confidentiality, and integrity to IP packets, ensuring that data remains secure even when traversing untrusted networks. IPsec can be combined with P2P GRE to create a robust and secure communication channel. The combination of P2P GRE and IPsec brings several benefits to network administrators and organizations. Firstly, it enables secure communication between geographically dispersed networks, allowing for seamless connectivity. Additionally, P2P GRE over IPsec provides strong encryption, ensuring the confidentiality of sensitive data. It also allows for the creation of virtual private networks (VPNs), offering a secure and private network environment. P2P GRE over IPsec finds applications in various scenarios. One common use case is connecting branch offices of an organization securely. By establishing a P2P GRE over IPsec tunnel between different locations, organizations can create a secure network environment for their remote sites. Another use case is securely connecting cloud resources to on-premises infrastructure, enabling secure and seamless integration. The role of GRE: In GRE, packets are wrapped within other packets that use supported protocols, allowing the use of protocols not generally supported by a network. To understand this, consider the difference between a car and a ferry. On land, cars travel on roads, while ferries travel on water. Usually, cars cannot travel on water but can be loaded onto ferries. In this analogy, terrain could be compared to a network that supports specific routing protocols and vehicles to data packets. Similarly, one type of vehicle (the car) is loaded onto a different kind of vehicle (the ferry) to cross terrain it could not otherwise. GRE tunneling: how does it work? GRE tunnels encapsulate packets within other packets. Each router represents the end of the tunnel. GRE packets are exchanged directly between routers. When routers are between forwarding packets, they use headers surrounding them rather than opening the encapsulated packets. Every packet of data sent over a network has the payload and the header. The payload contains the data being sent, while the headers contain information about the source and group of the packet. Each network protocol attaches a header to each packet. Unlike load limits on automobile bridges, data packet sizes are limited by MTU and MSS. An MSS measurement only measures a packet’s payload, not its headers. Including the headers, the MTU measures the total size of a packet. Packets that exceed MTU are fragmented to fit through the network. GRE configuration GRE Operation GRE is a layer three protocol, meaning it works at the IP level of the network. It enables a router to encapsulate packets of a particular protocol and send them to another router, where they are decapsulated and forwarded to their destination. This is useful for tunneling, where data must traverse multiple networks and different types of hardware. GRE encapsulates data in a header containing information about the source, destination, and other routing information. The GRE header is then encapsulated in an IP header containing the source and destination IP addresses. When the packet reaches the destination router, the GRE header is stripped off, and the data is sent to its destination. GRE over IPsec Understanding Multipoint GRE Multipoint GRE, or mGRE, is a tunneling protocol for encapsulating packets and transmitting them over an IP network. It enables virtual point-to-multipoint connections, allowing multiple endpoints to communicate simultaneously. By utilizing a single tunnel interface, mGRE simplifies network configurations and optimizes resource utilization. One of Multipoint GRE’s standout features is its ability to transport multicast and broadcast traffic across multiple sites efficiently. It achieves this through a single tunnel interface, eliminating the need for dedicated point-to-point connections. This scalability and flexibility make mGRE an excellent choice for large-scale deployments and multicast applications. DMVPN, as the name suggests, is a virtual private network technology that dynamically creates VPN connections between multiple sites without needing dedicated point-to-point links. It utilizes a hub-and-spoke architecture, with the hub as the central point for all communication. Using the Next Hop Resolution Protocol (NHRP), DMVPN provides a highly scalable and flexible solution for securely interconnecting sites. Multipoint GRE, or mGRE, is a tunneling protocol my DMVPN uses to create point-to-multipoint connections. It allows multiple spokes to communicate directly with each other, bypassing the hub. By encapsulating packets within GRE headers, mGRE establishes virtual links between spokes, providing a flexible and efficient method of data transmission.
USER:
Please summarize all of the major points in this article. Describe and explain the differences between the various protocols. Make sure to define them in relation to each other and the concepts discussed in the article so I can understand them better.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 42 | 1,203 | null | 58 |
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
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What are the requirements for providing expert evidence? Provide a step by step process of how an expert would present evidence in a court without referencing any specifics such as the type of expert or their specific field of expertise.
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Obligations of experts in New Zealand An “expert” is anyone with specialised knowledge or skill based on training, study or experience – it is not necessary for an expert to have formal qualifications (though, they often do).[1] In New Zealand, expert witnesses are not advocates — they have an overriding duty of impartiality to assist the Court.[2] The duty of impartiality is a fundamental tenet of giving expert evidence in New Zealand, in direct contrast to jurisdictions such as the United States, where experts are specifically selected as part of the advocacy team. The requirements of expert evidence in New Zealand are set out in the Evidence Act 2006 and the High Court Rules 2016, which sets out the prescribed Code of Conduct (the Code).[3] Expert evidence is only admissible if it is of “substantial help” to the judge,[4] and the expert’s conduct complies with the prescriptive requirements of the Code:[5] experts must read and agree to comply with the Code; experts must state their qualifications and confirm that the specific issues they address are properly within their expertise; experts must state all relevant facts, assumptions, reasoning, literature (or other material), testing or investigations relied on in reaching their opinion; and experts must appropriately qualify their opinions as necessary. In common law jurisdictions such as New Zealand, independent experts are engaged by the parties to the dispute. The Court may appoint its own independent expert, but this person must be agreed upon by the parties (if possible), or otherwise selected from experts named by the parties.[6] Once appointed, experts present evidence to the Court and are then examined by legal counsel, reflecting the adversarial nature of the common law system used in New Zealand. The adversarial court system will be immediately unfamiliar territory for European experts. For example, it is far more common in Germany for experts to be appointed by and primarily examined by the presiding judge.[7] Experts engaged by the parties are considered advocates, and their opinion will be considered as submissions (rather than evidence) by the Court.[8] In New Zealand, it is not a requirement that experts will disclose the scope of their engagements or the questions that have been put to them in their evidence. Nevertheless, we generally encourage this, as the nature of the questions put to an expert can be used as a measure of the expert’s independence (by checking if that the questions put to the witness are impartial and do not lead the witness to a particular answer). This is a mandatory requirement in England, Wales and Australia. If both parties have engaged experts to address the same issue of fact, the Court may direct that the witnesses confer and attempt to reach agreement on matters within their field of expertise.[9] This narrows the scope of the disputed issues, allowing for more efficient use of Court time. Consistent with their overriding duty to assist the Court, expert witnesses are obligated to comply with these directions. It is common practice for these obligations to be applied to arbitration proceedings based in New Zealand. In adjudication proceedings, where only a written “witness statement” is required, it is typical for experts to refer to the Code when providing evidence.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> What are the requirements for providing expert evidence? Provide a step by step process of how an expert would present evidence in a court without referencing any specifics such as the type of expert or their specific field of expertise. <TEXT> Obligations of experts in New Zealand An “expert” is anyone with specialised knowledge or skill based on training, study or experience – it is not necessary for an expert to have formal qualifications (though, they often do).[1] In New Zealand, expert witnesses are not advocates — they have an overriding duty of impartiality to assist the Court.[2] The duty of impartiality is a fundamental tenet of giving expert evidence in New Zealand, in direct contrast to jurisdictions such as the United States, where experts are specifically selected as part of the advocacy team. The requirements of expert evidence in New Zealand are set out in the Evidence Act 2006 and the High Court Rules 2016, which sets out the prescribed Code of Conduct (the Code).[3] Expert evidence is only admissible if it is of “substantial help” to the judge,[4] and the expert’s conduct complies with the prescriptive requirements of the Code:[5] experts must read and agree to comply with the Code; experts must state their qualifications and confirm that the specific issues they address are properly within their expertise; experts must state all relevant facts, assumptions, reasoning, literature (or other material), testing or investigations relied on in reaching their opinion; and experts must appropriately qualify their opinions as necessary. In common law jurisdictions such as New Zealand, independent experts are engaged by the parties to the dispute. The Court may appoint its own independent expert, but this person must be agreed upon by the parties (if possible), or otherwise selected from experts named by the parties.[6] Once appointed, experts present evidence to the Court and are then examined by legal counsel, reflecting the adversarial nature of the common law system used in New Zealand. The adversarial court system will be immediately unfamiliar territory for European experts. For example, it is far more common in Germany for experts to be appointed by and primarily examined by the presiding judge.[7] Experts engaged by the parties are considered advocates, and their opinion will be considered as submissions (rather than evidence) by the Court.[8] In New Zealand, it is not a requirement that experts will disclose the scope of their engagements or the questions that have been put to them in their evidence. Nevertheless, we generally encourage this, as the nature of the questions put to an expert can be used as a measure of the expert’s independence (by checking if that the questions put to the witness are impartial and do not lead the witness to a particular answer). This is a mandatory requirement in England, Wales and Australia. If both parties have engaged experts to address the same issue of fact, the Court may direct that the witnesses confer and attempt to reach agreement on matters within their field of expertise.[9] This narrows the scope of the disputed issues, allowing for more efficient use of Court time. Consistent with their overriding duty to assist the Court, expert witnesses are obligated to comply with these directions. It is common practice for these obligations to be applied to arbitration proceedings based in New Zealand. In adjudication proceedings, where only a written “witness statement” is required, it is typical for experts to refer to the Code when providing evidence. https://www.minterellison.co.nz/insights/calling-international-experts-an-introduction-to-giving-expert-evidence-in-new-zealand
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
Obligations of experts in New Zealand An “expert” is anyone with specialised knowledge or skill based on training, study or experience – it is not necessary for an expert to have formal qualifications (though, they often do).[1] In New Zealand, expert witnesses are not advocates — they have an overriding duty of impartiality to assist the Court.[2] The duty of impartiality is a fundamental tenet of giving expert evidence in New Zealand, in direct contrast to jurisdictions such as the United States, where experts are specifically selected as part of the advocacy team. The requirements of expert evidence in New Zealand are set out in the Evidence Act 2006 and the High Court Rules 2016, which sets out the prescribed Code of Conduct (the Code).[3] Expert evidence is only admissible if it is of “substantial help” to the judge,[4] and the expert’s conduct complies with the prescriptive requirements of the Code:[5] experts must read and agree to comply with the Code; experts must state their qualifications and confirm that the specific issues they address are properly within their expertise; experts must state all relevant facts, assumptions, reasoning, literature (or other material), testing or investigations relied on in reaching their opinion; and experts must appropriately qualify their opinions as necessary. In common law jurisdictions such as New Zealand, independent experts are engaged by the parties to the dispute. The Court may appoint its own independent expert, but this person must be agreed upon by the parties (if possible), or otherwise selected from experts named by the parties.[6] Once appointed, experts present evidence to the Court and are then examined by legal counsel, reflecting the adversarial nature of the common law system used in New Zealand. The adversarial court system will be immediately unfamiliar territory for European experts. For example, it is far more common in Germany for experts to be appointed by and primarily examined by the presiding judge.[7] Experts engaged by the parties are considered advocates, and their opinion will be considered as submissions (rather than evidence) by the Court.[8] In New Zealand, it is not a requirement that experts will disclose the scope of their engagements or the questions that have been put to them in their evidence. Nevertheless, we generally encourage this, as the nature of the questions put to an expert can be used as a measure of the expert’s independence (by checking if that the questions put to the witness are impartial and do not lead the witness to a particular answer). This is a mandatory requirement in England, Wales and Australia. If both parties have engaged experts to address the same issue of fact, the Court may direct that the witnesses confer and attempt to reach agreement on matters within their field of expertise.[9] This narrows the scope of the disputed issues, allowing for more efficient use of Court time. Consistent with their overriding duty to assist the Court, expert witnesses are obligated to comply with these directions. It is common practice for these obligations to be applied to arbitration proceedings based in New Zealand. In adjudication proceedings, where only a written “witness statement” is required, it is typical for experts to refer to the Code when providing evidence.
USER:
What are the requirements for providing expert evidence? Provide a step by step process of how an expert would present evidence in a court without referencing any specifics such as the type of expert or their specific field of expertise.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 40 | 534 | null | 644 |
This task requires you to answer questions based solely on the information provided in the prompt.
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According to this document, how did Youtube advertising revenue perform in Q1 2023?
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Ruth Porat, President and Chief Investment Officer; CFO, Alphabet and Google: Thank you, Philipp. We are very pleased with our financial results for the first quarter, driven in particular by strength in Search and Cloud, as well as the ongoing efforts to durably re-engineer our cost base. My comments will be on year-over-year comparisons for the first quarter, unless I state otherwise. I will start with results at the Alphabet level, followed by segment results, and conclude with our outlook. For the first quarter, our consolidated revenues were $80.5 billion, up 15% or up 16% in constant currency. Search remained the largest contributor to revenue growth. In terms of total expenses, the year-on-year comparisons reflect the impact of the restructuring charges we took in the first quarter of 2023, of $2.6 billion, as well as the $716 million in employee severance and related charges in the first quarter of 2024. As you can see in our earnings release, these charges were allocated across the expense lines in Other Cost of Revenues and OpEx based on associated headcount. To help with year-on-year comparisons, we included a table in our earnings release to adjust Other Cost of Revenues, operating expenses, operating income and operating margin to exclude the impact of severance and related office space charges in the first quarter of 2023 versus 2024. In terms of expenses, total Cost of Revenues was $33.7 billion, up 10%. Other Cost of Revenues was $20.8 billion, up 10% on a reported basis, with the increase driven primarily by content acquisition costs associated with YouTube, given the very strong revenue growth in both subscription offerings and ad-supported content. On an adjusted basis, Other Cost of Revenues were up 13% year-on-year. Operating expenses were $21.4 billion, down 2% on a reported basis, primarily reflecting expense decreases in sales and marketing and G&A, offset by an increase in R&D. The largest 10 single factor in the year-on-year decline in G&A expenses was lower charges related to legal matters. On an adjusted basis, operating expenses were up 5%, reflecting; first, in R&D, an increase in compensation expense, primarily for Google DeepMind and Cloud; and second, in Sales and Marketing a slight increase year-on-year, reflecting increases in compensation expense, primarily for Cloud sales. Operating income was $25.5 billion, up 46% on a reported basis, and our operating margin was 32%. On an adjusted basis, operating income was up 31%, and our operating margin was 33%. Net income was $23.7 billion, and EPS was $1.89. We delivered free cash flow of $16.8 billion in the first quarter and $69.1 billion for the trailing 12 months. We ended the quarter with $108 billion in cash and marketable securities. Turning to segment results, within Google Services, revenues were $70.4 billion, up 14%. Google Search & Other advertising revenues of $46.2 billion in the quarter were up 14%, led again by growth in retail. YouTube advertising revenues of $8.1 billion, were up 21%, driven by both direct response and brand advertising. Network advertising revenues of $7.4 billion were down 1%. Subscriptions, Platforms and Devices revenues were $8.7 billion, up 18%, primarily reflecting growth in YouTube subscription revenues. TAC was $12.9 billion, up 10%. Google Services Operating Income was $27.9 billion, up 28%, and the operating margin was 40%. Turning to the Google Cloud segment, revenues were $9.6 billion for the quarter, up 28%, reflecting significant growth in GCP, with an increasing contribution from AI and strong Google Workspace growth, primarily driven by increases in average revenue per seat. Google Cloud delivered Operating Income of $900 million and an operating margin of 9%. As to our Other Bets, for the first quarter, revenues were $495 million, benefiting from a milestone payment in one of the Other Bets. The operating loss was $1 billion. 11 Turning to our outlook for the business, with respect to Google Services. First, within Advertising, we are very pleased with the momentum of our Ads businesses. Search had broad-based strength across verticals. In YouTube, we had acceleration in revenue growth driven by brand and direct response. Looking ahead, two points to call out. First, results in our advertising business in Q1 continued to reflect strength in spend from APAC-based retailers, a trend that began in the second quarter of 2023 and continued through Q1, which means we will begin lapping that impact in the second quarter. Second, the YouTube acceleration in revenue growth in Q1 reflects, in part, lapping the negative year-on-year growth we experienced in the first quarter of 2023. Turning to Subscriptions, Platforms and Devices. We continue to deliver significant growth in our subscriptions business, which drives the majority of revenue growth in this line. The sequential quarterly decline in year-on-year revenue growth for the line in Q1, versus Q4, reflects, in part, the fact that we had only one week of Sunday Ticket subscription revenue in Q1 versus fourteen weeks in Q4. Looking forward, we will anniversary last year's price increase in YouTube TV starting in May. With regard to Platforms, we are pleased with the performance in Play driven by an increase in buyers. With respect to Google Cloud, performance in Q1 reflects strong demand for our GCP infrastructure and solutions, as well as the contribution from our Workspace productivity tools. The growth we are seeing across Cloud is underpinned by the benefit AI provides for our customers. We continue to invest aggressively, while remaining focused on profitable growth. As we look ahead, two points that will affect sequential year-on-year revenue growth comparisons across Alphabet. First, Q1 results reflect the benefit of Leap Year, which contributed slightly more than one point to our revenue growth rate at the consolidated level in the first quarter. Second, at current spot rates, we expect a larger headwind from foreign exchange in Q2 versus Q1. Turning to margins, our efforts to durably re-engineer our cost base are reflected in a 400 basis point expansion of our Alphabet operating margin year-on-year, excluding the impact of restructuring and severance charges in both periods. You can also see the impact in the quarter-on-quarter decline in headcount in Q1, which reflects 12 both actions we have taken over the past few months and a much slower pace of hiring. As we have discussed previously, we are continuing to invest in top engineering and technical talent, particularly in Cloud, Google DeepMind and Technical Infrastructure. Looking ahead, we remain focused on our efforts to moderate the pace of expense growth in order to create capacity for the increases in depreciation and expenses associated with the higher levels of investment in our technical infrastructure. We believe these efforts will enable us to deliver full-year 2024 Alphabet operating margin expansion relative to 2023. With respect to CapEx, our reported CapEx in the first quarter was $12 billion, once again driven overwhelmingly by investment in our technical infrastructure, with the largest component for servers, followed by data centers. The significant year-on-year growth in CapEx in recent quarters reflects our confidence in the opportunities offered by AI across our business. Looking ahead, we expect quarterly CapEx throughout the year to be roughly at or above the Q1 level, keeping in mind that the timing of cash payments can cause variability in quarterly reported CapEx. With regard to Other Bets, we similarly have workstreams under way to enhance overall returns. Finally, as I trust you saw in the press release, we are very pleased to be adding a quarterly dividend of $.20 per share to our capital return program, as well as a new $70 billion authorization in share repurchases. The core of our capital allocation framework remains the same, beginning with investing aggressively in our business as you have heard us talk about today, given the extraordinary opportunities ahead. We view the introduction of the dividend as further strengthening our overall capital return program. Thank you. Sundar, Philipp and I will now take your questions.
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System instruction: This task requires you to answer questions based solely on the information provided in the prompt. question: According to this document, how did Youtube advertising revenue perform in Q1 2023? context: Ruth Porat, President and Chief Investment Officer; CFO, Alphabet and Google: Thank you, Philipp. We are very pleased with our financial results for the first quarter, driven in particular by strength in Search and Cloud, as well as the ongoing efforts to durably re-engineer our cost base. My comments will be on year-over-year comparisons for the first quarter, unless I state otherwise. I will start with results at the Alphabet level, followed by segment results, and conclude with our outlook. For the first quarter, our consolidated revenues were $80.5 billion, up 15% or up 16% in constant currency. Search remained the largest contributor to revenue growth. In terms of total expenses, the year-on-year comparisons reflect the impact of the restructuring charges we took in the first quarter of 2023, of $2.6 billion, as well as the $716 million in employee severance and related charges in the first quarter of 2024. As you can see in our earnings release, these charges were allocated across the expense lines in Other Cost of Revenues and OpEx based on associated headcount. To help with year-on-year comparisons, we included a table in our earnings release to adjust Other Cost of Revenues, operating expenses, operating income and operating margin to exclude the impact of severance and related office space charges in the first quarter of 2023 versus 2024. In terms of expenses, total Cost of Revenues was $33.7 billion, up 10%. Other Cost of Revenues was $20.8 billion, up 10% on a reported basis, with the increase driven primarily by content acquisition costs associated with YouTube, given the very strong revenue growth in both subscription offerings and ad-supported content. On an adjusted basis, Other Cost of Revenues were up 13% year-on-year. Operating expenses were $21.4 billion, down 2% on a reported basis, primarily reflecting expense decreases in sales and marketing and G&A, offset by an increase in R&D. The largest 10 single factor in the year-on-year decline in G&A expenses was lower charges related to legal matters. On an adjusted basis, operating expenses were up 5%, reflecting; first, in R&D, an increase in compensation expense, primarily for Google DeepMind and Cloud; and second, in Sales and Marketing a slight increase year-on-year, reflecting increases in compensation expense, primarily for Cloud sales. Operating income was $25.5 billion, up 46% on a reported basis, and our operating margin was 32%. On an adjusted basis, operating income was up 31%, and our operating margin was 33%. Net income was $23.7 billion, and EPS was $1.89. We delivered free cash flow of $16.8 billion in the first quarter and $69.1 billion for the trailing 12 months. We ended the quarter with $108 billion in cash and marketable securities. Turning to segment results, within Google Services, revenues were $70.4 billion, up 14%. Google Search & Other advertising revenues of $46.2 billion in the quarter were up 14%, led again by growth in retail. YouTube advertising revenues of $8.1 billion, were up 21%, driven by both direct response and brand advertising. Network advertising revenues of $7.4 billion were down 1%. Subscriptions, Platforms and Devices revenues were $8.7 billion, up 18%, primarily reflecting growth in YouTube subscription revenues. TAC was $12.9 billion, up 10%. Google Services Operating Income was $27.9 billion, up 28%, and the operating margin was 40%. Turning to the Google Cloud segment, revenues were $9.6 billion for the quarter, up 28%, reflecting significant growth in GCP, with an increasing contribution from AI and strong Google Workspace growth, primarily driven by increases in average revenue per seat. Google Cloud delivered Operating Income of $900 million and an operating margin of 9%. As to our Other Bets, for the first quarter, revenues were $495 million, benefiting from a milestone payment in one of the Other Bets. The operating loss was $1 billion. 11 Turning to our outlook for the business, with respect to Google Services. First, within Advertising, we are very pleased with the momentum of our Ads businesses. Search had broad-based strength across verticals. In YouTube, we had acceleration in revenue growth driven by brand and direct response. Looking ahead, two points to call out. First, results in our advertising business in Q1 continued to reflect strength in spend from APAC-based retailers, a trend that began in the second quarter of 2023 and continued through Q1, which means we will begin lapping that impact in the second quarter. Second, the YouTube acceleration in revenue growth in Q1 reflects, in part, lapping the negative year-on-year growth we experienced in the first quarter of 2023. Turning to Subscriptions, Platforms and Devices. We continue to deliver significant growth in our subscriptions business, which drives the majority of revenue growth in this line. The sequential quarterly decline in year-on-year revenue growth for the line in Q1, versus Q4, reflects, in part, the fact that we had only one week of Sunday Ticket subscription revenue in Q1 versus fourteen weeks in Q4. Looking forward, we will anniversary last year's price increase in YouTube TV starting in May. With regard to Platforms, we are pleased with the performance in Play driven by an increase in buyers. With respect to Google Cloud, performance in Q1 reflects strong demand for our GCP infrastructure and solutions, as well as the contribution from our Workspace productivity tools. The growth we are seeing across Cloud is underpinned by the benefit AI provides for our customers. We continue to invest aggressively, while remaining focused on profitable growth. As we look ahead, two points that will affect sequential year-on-year revenue growth comparisons across Alphabet. First, Q1 results reflect the benefit of Leap Year, which contributed slightly more than one point to our revenue growth rate at the consolidated level in the first quarter. Second, at current spot rates, we expect a larger headwind from foreign exchange in Q2 versus Q1. Turning to margins, our efforts to durably re-engineer our cost base are reflected in a 400 basis point expansion of our Alphabet operating margin year-on-year, excluding the impact of restructuring and severance charges in both periods. You can also see the impact in the quarter-on-quarter decline in headcount in Q1, which reflects 12 both actions we have taken over the past few months and a much slower pace of hiring. As we have discussed previously, we are continuing to invest in top engineering and technical talent, particularly in Cloud, Google DeepMind and Technical Infrastructure. Looking ahead, we remain focused on our efforts to moderate the pace of expense growth in order to create capacity for the increases in depreciation and expenses associated with the higher levels of investment in our technical infrastructure. We believe these efforts will enable us to deliver full-year 2024 Alphabet operating margin expansion relative to 2023. With respect to CapEx, our reported CapEx in the first quarter was $12 billion, once again driven overwhelmingly by investment in our technical infrastructure, with the largest component for servers, followed by data centers. The significant year-on-year growth in CapEx in recent quarters reflects our confidence in the opportunities offered by AI across our business. Looking ahead, we expect quarterly CapEx throughout the year to be roughly at or above the Q1 level, keeping in mind that the timing of cash payments can cause variability in quarterly reported CapEx. With regard to Other Bets, we similarly have workstreams under way to enhance overall returns. Finally, as I trust you saw in the press release, we are very pleased to be adding a quarterly dividend of $.20 per share to our capital return program, as well as a new $70 billion authorization in share repurchases. The core of our capital allocation framework remains the same, beginning with investing aggressively in our business as you have heard us talk about today, given the extraordinary opportunities ahead. We view the introduction of the dividend as further strengthening our overall capital return program. Thank you. Sundar, Philipp and I will now take your questions.
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This task requires you to answer questions based solely on the information provided in the prompt.
EVIDENCE:
Ruth Porat, President and Chief Investment Officer; CFO, Alphabet and Google: Thank you, Philipp. We are very pleased with our financial results for the first quarter, driven in particular by strength in Search and Cloud, as well as the ongoing efforts to durably re-engineer our cost base. My comments will be on year-over-year comparisons for the first quarter, unless I state otherwise. I will start with results at the Alphabet level, followed by segment results, and conclude with our outlook. For the first quarter, our consolidated revenues were $80.5 billion, up 15% or up 16% in constant currency. Search remained the largest contributor to revenue growth. In terms of total expenses, the year-on-year comparisons reflect the impact of the restructuring charges we took in the first quarter of 2023, of $2.6 billion, as well as the $716 million in employee severance and related charges in the first quarter of 2024. As you can see in our earnings release, these charges were allocated across the expense lines in Other Cost of Revenues and OpEx based on associated headcount. To help with year-on-year comparisons, we included a table in our earnings release to adjust Other Cost of Revenues, operating expenses, operating income and operating margin to exclude the impact of severance and related office space charges in the first quarter of 2023 versus 2024. In terms of expenses, total Cost of Revenues was $33.7 billion, up 10%. Other Cost of Revenues was $20.8 billion, up 10% on a reported basis, with the increase driven primarily by content acquisition costs associated with YouTube, given the very strong revenue growth in both subscription offerings and ad-supported content. On an adjusted basis, Other Cost of Revenues were up 13% year-on-year. Operating expenses were $21.4 billion, down 2% on a reported basis, primarily reflecting expense decreases in sales and marketing and G&A, offset by an increase in R&D. The largest 10 single factor in the year-on-year decline in G&A expenses was lower charges related to legal matters. On an adjusted basis, operating expenses were up 5%, reflecting; first, in R&D, an increase in compensation expense, primarily for Google DeepMind and Cloud; and second, in Sales and Marketing a slight increase year-on-year, reflecting increases in compensation expense, primarily for Cloud sales. Operating income was $25.5 billion, up 46% on a reported basis, and our operating margin was 32%. On an adjusted basis, operating income was up 31%, and our operating margin was 33%. Net income was $23.7 billion, and EPS was $1.89. We delivered free cash flow of $16.8 billion in the first quarter and $69.1 billion for the trailing 12 months. We ended the quarter with $108 billion in cash and marketable securities. Turning to segment results, within Google Services, revenues were $70.4 billion, up 14%. Google Search & Other advertising revenues of $46.2 billion in the quarter were up 14%, led again by growth in retail. YouTube advertising revenues of $8.1 billion, were up 21%, driven by both direct response and brand advertising. Network advertising revenues of $7.4 billion were down 1%. Subscriptions, Platforms and Devices revenues were $8.7 billion, up 18%, primarily reflecting growth in YouTube subscription revenues. TAC was $12.9 billion, up 10%. Google Services Operating Income was $27.9 billion, up 28%, and the operating margin was 40%. Turning to the Google Cloud segment, revenues were $9.6 billion for the quarter, up 28%, reflecting significant growth in GCP, with an increasing contribution from AI and strong Google Workspace growth, primarily driven by increases in average revenue per seat. Google Cloud delivered Operating Income of $900 million and an operating margin of 9%. As to our Other Bets, for the first quarter, revenues were $495 million, benefiting from a milestone payment in one of the Other Bets. The operating loss was $1 billion. 11 Turning to our outlook for the business, with respect to Google Services. First, within Advertising, we are very pleased with the momentum of our Ads businesses. Search had broad-based strength across verticals. In YouTube, we had acceleration in revenue growth driven by brand and direct response. Looking ahead, two points to call out. First, results in our advertising business in Q1 continued to reflect strength in spend from APAC-based retailers, a trend that began in the second quarter of 2023 and continued through Q1, which means we will begin lapping that impact in the second quarter. Second, the YouTube acceleration in revenue growth in Q1 reflects, in part, lapping the negative year-on-year growth we experienced in the first quarter of 2023. Turning to Subscriptions, Platforms and Devices. We continue to deliver significant growth in our subscriptions business, which drives the majority of revenue growth in this line. The sequential quarterly decline in year-on-year revenue growth for the line in Q1, versus Q4, reflects, in part, the fact that we had only one week of Sunday Ticket subscription revenue in Q1 versus fourteen weeks in Q4. Looking forward, we will anniversary last year's price increase in YouTube TV starting in May. With regard to Platforms, we are pleased with the performance in Play driven by an increase in buyers. With respect to Google Cloud, performance in Q1 reflects strong demand for our GCP infrastructure and solutions, as well as the contribution from our Workspace productivity tools. The growth we are seeing across Cloud is underpinned by the benefit AI provides for our customers. We continue to invest aggressively, while remaining focused on profitable growth. As we look ahead, two points that will affect sequential year-on-year revenue growth comparisons across Alphabet. First, Q1 results reflect the benefit of Leap Year, which contributed slightly more than one point to our revenue growth rate at the consolidated level in the first quarter. Second, at current spot rates, we expect a larger headwind from foreign exchange in Q2 versus Q1. Turning to margins, our efforts to durably re-engineer our cost base are reflected in a 400 basis point expansion of our Alphabet operating margin year-on-year, excluding the impact of restructuring and severance charges in both periods. You can also see the impact in the quarter-on-quarter decline in headcount in Q1, which reflects 12 both actions we have taken over the past few months and a much slower pace of hiring. As we have discussed previously, we are continuing to invest in top engineering and technical talent, particularly in Cloud, Google DeepMind and Technical Infrastructure. Looking ahead, we remain focused on our efforts to moderate the pace of expense growth in order to create capacity for the increases in depreciation and expenses associated with the higher levels of investment in our technical infrastructure. We believe these efforts will enable us to deliver full-year 2024 Alphabet operating margin expansion relative to 2023. With respect to CapEx, our reported CapEx in the first quarter was $12 billion, once again driven overwhelmingly by investment in our technical infrastructure, with the largest component for servers, followed by data centers. The significant year-on-year growth in CapEx in recent quarters reflects our confidence in the opportunities offered by AI across our business. Looking ahead, we expect quarterly CapEx throughout the year to be roughly at or above the Q1 level, keeping in mind that the timing of cash payments can cause variability in quarterly reported CapEx. With regard to Other Bets, we similarly have workstreams under way to enhance overall returns. Finally, as I trust you saw in the press release, we are very pleased to be adding a quarterly dividend of $.20 per share to our capital return program, as well as a new $70 billion authorization in share repurchases. The core of our capital allocation framework remains the same, beginning with investing aggressively in our business as you have heard us talk about today, given the extraordinary opportunities ahead. We view the introduction of the dividend as further strengthening our overall capital return program. Thank you. Sundar, Philipp and I will now take your questions.
USER:
According to this document, how did Youtube advertising revenue perform in Q1 2023?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 16 | 13 | 1,315 | null | 723 |
You may only answer questions based solely on the information in the context block. You may not use any external sources or knowledge.
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What does a positive Stemmer sign indicate?
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CLINICAL MANIFESTATIONS OF LIPEDEMA It is defined as a chronic disease that predominantly affects women and it is normally first noticed at puberty, pregnancy or menopause1,15. In 97% of the cases lipedema is located in lower limbs and in 31% in upper extremities14 . Patients present a symmetrical and abnormal increase of adipose tissue from the hips, involving the buttocks as well as the regions of thigh and calf (Figure 1c). The enlargement of the lower limbs is disproportionate in relation to the upper part of the body16 . Patients complain that edema in lower limbs may worsen in the afternoon or evening and increased swelling is often related to the orthostasis and heat with an increased sensitivity to pain and appearance of spontaneous or minimal trauma-induced bruising. Other symptoms include plantar arch abnormalities, cold skin and spontaneous pain. As lipedema progresses a significant volume excess is associated, and the occurrence of hip and knee joint damage that lead to orthopedic disorders adds gait alterations thus complicating the patient’s life (Figure 4d). In severe stages, the lymphatic system becomes decompensated to various degrees and it can also associate uni- or rather bilateral lymphedema that can be suspected with the swelling of the dorsum of the foot, a positive Stemmer sign (the inability to pinch a fold of skin at the base of the second toe due to thickening of the skin and subcutaneous tissues) or deep skin folds. The combination of lymphatic insufficiency and lipedema is called lipolymphedema or lympholipedema depending on the terminology (Figure 2). Concomitance with severe venous insufficiency is rare; however, varicosity is often seen among lipedematous patients17. We must bear in mind that lipedema is often combined with obesity and the clinical diagnosis may be confused as lipedema sufferers are commonly heavily overweight.
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System instruction: [You may only answer questions based solely on the information in the context block. You may not use any external sources or knowledge.] question: [What does a positive Stemmer sign indicate?] context block: [CLINICAL MANIFESTATIONS OF LIPEDEMA It is defined as a chronic disease that predominantly affects women and it is normally first noticed at puberty, pregnancy or menopause1,15. In 97% of the cases lipedema is located in lower limbs and in 31% in upper extremities14 . Patients present a symmetrical and abnormal increase of adipose tissue from the hips, involving the buttocks as well as the regions of thigh and calf (Figure 1c). The enlargement of the lower limbs is disproportionate in relation to the upper part of the body16 . Patients complain that edema in lower limbs may worsen in the afternoon or evening and increased swelling is often related to the orthostasis and heat with an increased sensitivity to pain and appearance of spontaneous or minimal trauma-induced bruising. Other symptoms include plantar arch abnormalities, cold skin and spontaneous pain. As lipedema progresses a significant volume excess is associated, and the occurrence of hip and knee joint damage that lead to orthopedic disorders adds gait alterations thus complicating the patient’s life (Figure 4d). In severe stages, the lymphatic system becomes decompensated to various degrees and it can also associate uni- or rather bilateral lymphedema that can be suspected with the swelling of the dorsum of the foot, a positive Stemmer sign (the inability to pinch a fold of skin at the base of the second toe due to thickening of the skin and subcutaneous tissues) or deep skin folds. The combination of lymphatic insufficiency and lipedema is called lipolymphedema or lympholipedema depending on the terminology (Figure 2). Concomitance with severe venous insufficiency is rare; however, varicosity is often seen among lipedematous patients17. We must bear in mind that lipedema is often combined with obesity and the clinical diagnosis may be confused as lipedema sufferers are commonly heavily overweight. ]
|
You may only answer questions based solely on the information in the context block. You may not use any external sources or knowledge.
EVIDENCE:
CLINICAL MANIFESTATIONS OF LIPEDEMA It is defined as a chronic disease that predominantly affects women and it is normally first noticed at puberty, pregnancy or menopause1,15. In 97% of the cases lipedema is located in lower limbs and in 31% in upper extremities14 . Patients present a symmetrical and abnormal increase of adipose tissue from the hips, involving the buttocks as well as the regions of thigh and calf (Figure 1c). The enlargement of the lower limbs is disproportionate in relation to the upper part of the body16 . Patients complain that edema in lower limbs may worsen in the afternoon or evening and increased swelling is often related to the orthostasis and heat with an increased sensitivity to pain and appearance of spontaneous or minimal trauma-induced bruising. Other symptoms include plantar arch abnormalities, cold skin and spontaneous pain. As lipedema progresses a significant volume excess is associated, and the occurrence of hip and knee joint damage that lead to orthopedic disorders adds gait alterations thus complicating the patient’s life (Figure 4d). In severe stages, the lymphatic system becomes decompensated to various degrees and it can also associate uni- or rather bilateral lymphedema that can be suspected with the swelling of the dorsum of the foot, a positive Stemmer sign (the inability to pinch a fold of skin at the base of the second toe due to thickening of the skin and subcutaneous tissues) or deep skin folds. The combination of lymphatic insufficiency and lipedema is called lipolymphedema or lympholipedema depending on the terminology (Figure 2). Concomitance with severe venous insufficiency is rare; however, varicosity is often seen among lipedematous patients17. We must bear in mind that lipedema is often combined with obesity and the clinical diagnosis may be confused as lipedema sufferers are commonly heavily overweight.
USER:
What does a positive Stemmer sign indicate?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 23 | 7 | 297 | null | 439 |
Only utilize the information in the article provided to answer the question, do not refer to any outside information. Answer the question in full sentences.
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What are 5 goals of Customer Relationship Management Systems implementation within an enterprise?
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**Customer Relationship Management Systems** What is a CRM system? A CRM system gathers, links, and analyses all collected customer data, including contact information, interactions with company representatives, purchases, service requests, assets, and quotes/proposals. The system then lets users access that data and understand what happened at each touchpoint. Through this understanding, a complete customer profile is developed, and a solid customer relationship is built. Customer data can also be aggregated to populate incentive compensation modelling, sales forecasting, territory segmentation, campaign design, product innovation, and other sales, marketing, and customer service activities. CRM tools and software help you streamline the customer engagement process, close more sales deals, establish strong customer relationships, build customer loyalty, and ultimately increase sales and profits. Learn more about Oracle's comprehensive CRM sales solution Who should use a CRM? CRM tools have almost always been seen as sales tools. However, over time, these solutions have extended their reach and become integral to marketing, ecommerce, and customer service functions. The power of customer relationship management is derived by constantly gathering customer data, analysing that data, and then using those insights to deepen relationships and improve business results. It allows any customer-facing employee to convey, "We know you, and we value you." A set of data-driven CRM tools supports you beyond the sales process, which is crucial to business performance. With the in-depth knowledge of your customers, you can: Offer and sell new, add-on products—at the right time in the right way at the right price Help customer service teams resolve issues faster Help development teams create better products and services CRM: What is the goal? CRM software supports strong, productive, loyal customer relationships through informed and superior customer experiences. The goal? To improve customer acquisition and retention by providing experiences that keep your customers coming back. Customer relationship management is both a strategy and a tool that supports those experiences in five key ways. 1 Answer the most basic customer questions Customer relationship management helps you find new customers, sell to them, and develop a loyal customer relationship with them. These systems collect many different types of customer data and organize it so you understand your customers/prospects better and can answer (or even anticipate) their questions. 2 Manage customer data Bad decisions come from a lack of access to and inability to interpret customer data. Being able to store, track, and validate customer data within an automated system will allow sales and marketing teams to optimize customer engagement strategies and build better relationships. 3 Automate the sales process Sales force automation makes selling more efficient, helping you sell more quickly. The best CRM systems use artificial intelligence (AI) and unified customer data to automate the sales process by prompting sellers with recommended next-best actions. 4 Personalize marketing campaigns Customers and potential customers arrive through various channels, including websites, social media, email, online/offline events, etc. Unfortunately, many businesses struggle to connect marketing efforts across all these channels. Marketing teams can improve conversions, strengthen customer relationships, and align messaging across their digital customer channels by leveraging CRM systems. 5 Align sales and marketing With customer relationship management, marketing and sales work better together to drive sales and increase revenue. When sales and marketing are in sync, sales productivity goes up along with marketing ROI. CRM features and benefits Customer relationship management solutions are one of the largest and fastest-growing enterprise application software categories. The CRM market size was valued at $41.93 billion in 2019 and is projected to reach $96.39 billion by 2027, growing at a CAGR of 11.1% from 2020 to 2027. More and more companies are using CRM solutions to acquire more sales leads, improve the sales pipeline, boost productivity, and improve customer satisfaction. However, many have encountered problems ranging from cost overruns and CRM integration challenges to system limitations. These are avoidable problems, and you can help ensure success by focusing on a customer-first strategy. It's critical for businesses to have integrated, customizable, and comprehensive views into their customers’ and potential customers’ solution/product interests, customer service needs, and purchase history. A good CRM system should provide that view. All data is in a single location, viewable through optimized dashboards. Additionally, your marketing team can leverage CRM solutions to orchestrate personalized marketing and lead generation campaigns. These systems can help track all cross-channel interactions—from engagement to purchase. Mature cloud CRM solutions do more. They are fully integrated with back-office solutions to successfully support the entire customer journey. Because it manages prospect and customer engagement points across all channels, your CRM system can inform all your communications and marketing activities, delivering the 360-degree customer view needed for a truly connected omnichannel experience. Many different vendors have many different types of solutions. However, a few capabilities are must-haves. Be easy to use, or people won't use it Fit within your budget and provide an acceptable ROI Integrate well with your other software systems Provide accurate, consistent data for that much-needed, complete customer 360-degree view Types of CRM CRM software solutions, at their core, are used to manage customer relationships and sales interactions. Still, many businesses leverage these systems simply as a sales force automation tool. But these solutions, such as Oracle's, offer many more valuable capabilities that span a wide range of marketing and sales functions, including marketing, customer service, sales, and partner channel management. Today’s CRM software can support the entire customer journey. But what one company may need from a CRM system can be vastly different from what another company might require. To help you select the right CRM for your organization, it’s helpful to know that there are three main types of CRM solutions: collaborative, operational, and analytical. CRM and data Data is the most critical part of any CRM software solution. In fact, customer data is the starting point for all marketing and sales activities. Successful customer engagement and relationship strategies hinge on accurate, complete, and accessible customer profiles. Bad data comes from several places, including: Fraudulently entered data Keystroke errors Duplicate customer information Natural changes (company bankruptcy, job changes) Incomplete and inaccurate data can increase quickly to degrade the value of your CRM tools, resulting in unnecessary expenses. Conversely, when customer data is complete and accurate, businesses stand a better chance of reaching their target customers and prospects. In short, your data is a valuable asset. So it’s important to focus on collecting and optimizing these four CRM data types: Identity data Identity data includes descriptive details to identify customers, leads, and contacts. This data should be used for marketing segmentation. Descriptive data Descriptive data includes lifestyle details relevant to your contacts. It is what completes that all-important 360-degree view of leads and contacts. Quantitative data Quantitative data includes measurable data points that can help you interpret how your leads and contacts have interacted with you. Qualitative data Qualitative data can help you better understand your contacts’ intent, including search behaviours related to buying decisions. CRM vs. marketing automation Both CRM and marketing automation systems are data-driven. They focus on gathering, storing, and using data. For example, marketing automation systems gather leads by communicating with potential and current customers. Specifically, marketing automation looks to gather enough customer data points to show intent and then hands that person off to the sales team as a marketing-qualified lead (MQL). A CRM solution picks up where the marketing automation solution left off and works to convert those marketing-qualified leads into contacts. AI in CRM Discover the next generation of CRM (0:38) The best CRM systems offer robust analytics coupled with AI and machine learning. AI is the future of customer relationship management, going beyond contact management and sales force automation to truly helping you sell. AI in CRM can guide you toward the next-best actions and provide smart talking points—specific to each customer opportunity. AI also delivers timely customer intelligence that helps you optimize customer experience (CX) across marketing, sales, and customer service. CRM vs. CX When customer relationship management first arrived on the scene, businesses would capture data but not know what to do with it. Today, CRM systems are integrated with AI, which helps interpret and predict what that data means. CRM AI capabilities are the foundation to using a 360-degree view of the customer that will start them on their way to becoming your customer. As these AI enhancements continue to evolve, CX will continue to improve—and in turn, customer expectations will continue to increase. Your business needs to fully understand your customers (and how they buy) to not only meet their expectations but to provide them with compelling experiences. This is the future of CX and should serve as your guide to selecting the best CRM solution. How CRM improves customer experience A complete customer view is necessary for business success and growth. Without a CRM system, you'll struggle to develop that much-needed 360-degree view of the customer that you need to: Personalize customer interactions Automate business processes (with appropriate CX integrations) Track all customer interactions
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{Context} ========== **Customer Relationship Management Systems** What is a CRM system? A CRM system gathers, links, and analyses all collected customer data, including contact information, interactions with company representatives, purchases, service requests, assets, and quotes/proposals. The system then lets users access that data and understand what happened at each touchpoint. Through this understanding, a complete customer profile is developed, and a solid customer relationship is built. Customer data can also be aggregated to populate incentive compensation modelling, sales forecasting, territory segmentation, campaign design, product innovation, and other sales, marketing, and customer service activities. CRM tools and software help you streamline the customer engagement process, close more sales deals, establish strong customer relationships, build customer loyalty, and ultimately increase sales and profits. Learn more about Oracle's comprehensive CRM sales solution Who should use a CRM? CRM tools have almost always been seen as sales tools. However, over time, these solutions have extended their reach and become integral to marketing, ecommerce, and customer service functions. The power of customer relationship management is derived by constantly gathering customer data, analysing that data, and then using those insights to deepen relationships and improve business results. It allows any customer-facing employee to convey, "We know you, and we value you." A set of data-driven CRM tools supports you beyond the sales process, which is crucial to business performance. With the in-depth knowledge of your customers, you can: Offer and sell new, add-on products—at the right time in the right way at the right price Help customer service teams resolve issues faster Help development teams create better products and services CRM: What is the goal? CRM software supports strong, productive, loyal customer relationships through informed and superior customer experiences. The goal? To improve customer acquisition and retention by providing experiences that keep your customers coming back. Customer relationship management is both a strategy and a tool that supports those experiences in five key ways. 1 Answer the most basic customer questions Customer relationship management helps you find new customers, sell to them, and develop a loyal customer relationship with them. These systems collect many different types of customer data and organize it so you understand your customers/prospects better and can answer (or even anticipate) their questions. 2 Manage customer data Bad decisions come from a lack of access to and inability to interpret customer data. Being able to store, track, and validate customer data within an automated system will allow sales and marketing teams to optimize customer engagement strategies and build better relationships. 3 Automate the sales process Sales force automation makes selling more efficient, helping you sell more quickly. The best CRM systems use artificial intelligence (AI) and unified customer data to automate the sales process by prompting sellers with recommended next-best actions. 4 Personalize marketing campaigns Customers and potential customers arrive through various channels, including websites, social media, email, online/offline events, etc. Unfortunately, many businesses struggle to connect marketing efforts across all these channels. Marketing teams can improve conversions, strengthen customer relationships, and align messaging across their digital customer channels by leveraging CRM systems. 5 Align sales and marketing With customer relationship management, marketing and sales work better together to drive sales and increase revenue. When sales and marketing are in sync, sales productivity goes up along with marketing ROI. CRM features and benefits Customer relationship management solutions are one of the largest and fastest-growing enterprise application software categories. The CRM market size was valued at $41.93 billion in 2019 and is projected to reach $96.39 billion by 2027, growing at a CAGR of 11.1% from 2020 to 2027. More and more companies are using CRM solutions to acquire more sales leads, improve the sales pipeline, boost productivity, and improve customer satisfaction. However, many have encountered problems ranging from cost overruns and CRM integration challenges to system limitations. These are avoidable problems, and you can help ensure success by focusing on a customer-first strategy. It's critical for businesses to have integrated, customizable, and comprehensive views into their customers’ and potential customers’ solution/product interests, customer service needs, and purchase history. A good CRM system should provide that view. All data is in a single location, viewable through optimized dashboards. Additionally, your marketing team can leverage CRM solutions to orchestrate personalized marketing and lead generation campaigns. These systems can help track all cross-channel interactions—from engagement to purchase. Mature cloud CRM solutions do more. They are fully integrated with back-office solutions to successfully support the entire customer journey. Because it manages prospect and customer engagement points across all channels, your CRM system can inform all your communications and marketing activities, delivering the 360-degree customer view needed for a truly connected omnichannel experience. Many different vendors have many different types of solutions. However, a few capabilities are must-haves. Be easy to use, or people won't use it Fit within your budget and provide an acceptable ROI Integrate well with your other software systems Provide accurate, consistent data for that much-needed, complete customer 360-degree view Types of CRM CRM software solutions, at their core, are used to manage customer relationships and sales interactions. Still, many businesses leverage these systems simply as a sales force automation tool. But these solutions, such as Oracle's, offer many more valuable capabilities that span a wide range of marketing and sales functions, including marketing, customer service, sales, and partner channel management. Today’s CRM software can support the entire customer journey. But what one company may need from a CRM system can be vastly different from what another company might require. To help you select the right CRM for your organization, it’s helpful to know that there are three main types of CRM solutions: collaborative, operational, and analytical. CRM and data Data is the most critical part of any CRM software solution. In fact, customer data is the starting point for all marketing and sales activities. Successful customer engagement and relationship strategies hinge on accurate, complete, and accessible customer profiles. Bad data comes from several places, including: Fraudulently entered data Keystroke errors Duplicate customer information Natural changes (company bankruptcy, job changes) Incomplete and inaccurate data can increase quickly to degrade the value of your CRM tools, resulting in unnecessary expenses. Conversely, when customer data is complete and accurate, businesses stand a better chance of reaching their target customers and prospects. In short, your data is a valuable asset. So it’s important to focus on collecting and optimizing these four CRM data types: Identity data Identity data includes descriptive details to identify customers, leads, and contacts. This data should be used for marketing segmentation. Descriptive data Descriptive data includes lifestyle details relevant to your contacts. It is what completes that all-important 360-degree view of leads and contacts. Quantitative data Quantitative data includes measurable data points that can help you interpret how your leads and contacts have interacted with you. Qualitative data Qualitative data can help you better understand your contacts’ intent, including search behaviours related to buying decisions. CRM vs. marketing automation Both CRM and marketing automation systems are data-driven. They focus on gathering, storing, and using data. For example, marketing automation systems gather leads by communicating with potential and current customers. Specifically, marketing automation looks to gather enough customer data points to show intent and then hands that person off to the sales team as a marketing-qualified lead (MQL). A CRM solution picks up where the marketing automation solution left off and works to convert those marketing-qualified leads into contacts. AI in CRM Discover the next generation of CRM (0:38) The best CRM systems offer robust analytics coupled with AI and machine learning. AI is the future of customer relationship management, going beyond contact management and sales force automation to truly helping you sell. AI in CRM can guide you toward the next-best actions and provide smart talking points—specific to each customer opportunity. AI also delivers timely customer intelligence that helps you optimize customer experience (CX) across marketing, sales, and customer service. CRM vs. CX When customer relationship management first arrived on the scene, businesses would capture data but not know what to do with it. Today, CRM systems are integrated with AI, which helps interpret and predict what that data means. CRM AI capabilities are the foundation to using a 360-degree view of the customer that will start them on their way to becoming your customer. As these AI enhancements continue to evolve, CX will continue to improve—and in turn, customer expectations will continue to increase. Your business needs to fully understand your customers (and how they buy) to not only meet their expectations but to provide them with compelling experiences. This is the future of CX and should serve as your guide to selecting the best CRM solution. How CRM improves customer experience A complete customer view is necessary for business success and growth. Without a CRM system, you'll struggle to develop that much-needed 360-degree view of the customer that you need to: Personalize customer interactions Automate business processes (with appropriate CX integrations) Track all customer interactions {Query} ========== What are 5 goals of Customer Relationship Management Systems implementation within an enterprise? {Task Instruction} ========== Only utilize the information in the article provided to answer the question, do not refer to any outside information. Answer the question in full sentences.
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Only utilize the information in the article provided to answer the question, do not refer to any outside information. Answer the question in full sentences.
EVIDENCE:
**Customer Relationship Management Systems** What is a CRM system? A CRM system gathers, links, and analyses all collected customer data, including contact information, interactions with company representatives, purchases, service requests, assets, and quotes/proposals. The system then lets users access that data and understand what happened at each touchpoint. Through this understanding, a complete customer profile is developed, and a solid customer relationship is built. Customer data can also be aggregated to populate incentive compensation modelling, sales forecasting, territory segmentation, campaign design, product innovation, and other sales, marketing, and customer service activities. CRM tools and software help you streamline the customer engagement process, close more sales deals, establish strong customer relationships, build customer loyalty, and ultimately increase sales and profits. Learn more about Oracle's comprehensive CRM sales solution Who should use a CRM? CRM tools have almost always been seen as sales tools. However, over time, these solutions have extended their reach and become integral to marketing, ecommerce, and customer service functions. The power of customer relationship management is derived by constantly gathering customer data, analysing that data, and then using those insights to deepen relationships and improve business results. It allows any customer-facing employee to convey, "We know you, and we value you." A set of data-driven CRM tools supports you beyond the sales process, which is crucial to business performance. With the in-depth knowledge of your customers, you can: Offer and sell new, add-on products—at the right time in the right way at the right price Help customer service teams resolve issues faster Help development teams create better products and services CRM: What is the goal? CRM software supports strong, productive, loyal customer relationships through informed and superior customer experiences. The goal? To improve customer acquisition and retention by providing experiences that keep your customers coming back. Customer relationship management is both a strategy and a tool that supports those experiences in five key ways. 1 Answer the most basic customer questions Customer relationship management helps you find new customers, sell to them, and develop a loyal customer relationship with them. These systems collect many different types of customer data and organize it so you understand your customers/prospects better and can answer (or even anticipate) their questions. 2 Manage customer data Bad decisions come from a lack of access to and inability to interpret customer data. Being able to store, track, and validate customer data within an automated system will allow sales and marketing teams to optimize customer engagement strategies and build better relationships. 3 Automate the sales process Sales force automation makes selling more efficient, helping you sell more quickly. The best CRM systems use artificial intelligence (AI) and unified customer data to automate the sales process by prompting sellers with recommended next-best actions. 4 Personalize marketing campaigns Customers and potential customers arrive through various channels, including websites, social media, email, online/offline events, etc. Unfortunately, many businesses struggle to connect marketing efforts across all these channels. Marketing teams can improve conversions, strengthen customer relationships, and align messaging across their digital customer channels by leveraging CRM systems. 5 Align sales and marketing With customer relationship management, marketing and sales work better together to drive sales and increase revenue. When sales and marketing are in sync, sales productivity goes up along with marketing ROI. CRM features and benefits Customer relationship management solutions are one of the largest and fastest-growing enterprise application software categories. The CRM market size was valued at $41.93 billion in 2019 and is projected to reach $96.39 billion by 2027, growing at a CAGR of 11.1% from 2020 to 2027. More and more companies are using CRM solutions to acquire more sales leads, improve the sales pipeline, boost productivity, and improve customer satisfaction. However, many have encountered problems ranging from cost overruns and CRM integration challenges to system limitations. These are avoidable problems, and you can help ensure success by focusing on a customer-first strategy. It's critical for businesses to have integrated, customizable, and comprehensive views into their customers’ and potential customers’ solution/product interests, customer service needs, and purchase history. A good CRM system should provide that view. All data is in a single location, viewable through optimized dashboards. Additionally, your marketing team can leverage CRM solutions to orchestrate personalized marketing and lead generation campaigns. These systems can help track all cross-channel interactions—from engagement to purchase. Mature cloud CRM solutions do more. They are fully integrated with back-office solutions to successfully support the entire customer journey. Because it manages prospect and customer engagement points across all channels, your CRM system can inform all your communications and marketing activities, delivering the 360-degree customer view needed for a truly connected omnichannel experience. Many different vendors have many different types of solutions. However, a few capabilities are must-haves. Be easy to use, or people won't use it Fit within your budget and provide an acceptable ROI Integrate well with your other software systems Provide accurate, consistent data for that much-needed, complete customer 360-degree view Types of CRM CRM software solutions, at their core, are used to manage customer relationships and sales interactions. Still, many businesses leverage these systems simply as a sales force automation tool. But these solutions, such as Oracle's, offer many more valuable capabilities that span a wide range of marketing and sales functions, including marketing, customer service, sales, and partner channel management. Today’s CRM software can support the entire customer journey. But what one company may need from a CRM system can be vastly different from what another company might require. To help you select the right CRM for your organization, it’s helpful to know that there are three main types of CRM solutions: collaborative, operational, and analytical. CRM and data Data is the most critical part of any CRM software solution. In fact, customer data is the starting point for all marketing and sales activities. Successful customer engagement and relationship strategies hinge on accurate, complete, and accessible customer profiles. Bad data comes from several places, including: Fraudulently entered data Keystroke errors Duplicate customer information Natural changes (company bankruptcy, job changes) Incomplete and inaccurate data can increase quickly to degrade the value of your CRM tools, resulting in unnecessary expenses. Conversely, when customer data is complete and accurate, businesses stand a better chance of reaching their target customers and prospects. In short, your data is a valuable asset. So it’s important to focus on collecting and optimizing these four CRM data types: Identity data Identity data includes descriptive details to identify customers, leads, and contacts. This data should be used for marketing segmentation. Descriptive data Descriptive data includes lifestyle details relevant to your contacts. It is what completes that all-important 360-degree view of leads and contacts. Quantitative data Quantitative data includes measurable data points that can help you interpret how your leads and contacts have interacted with you. Qualitative data Qualitative data can help you better understand your contacts’ intent, including search behaviours related to buying decisions. CRM vs. marketing automation Both CRM and marketing automation systems are data-driven. They focus on gathering, storing, and using data. For example, marketing automation systems gather leads by communicating with potential and current customers. Specifically, marketing automation looks to gather enough customer data points to show intent and then hands that person off to the sales team as a marketing-qualified lead (MQL). A CRM solution picks up where the marketing automation solution left off and works to convert those marketing-qualified leads into contacts. AI in CRM Discover the next generation of CRM (0:38) The best CRM systems offer robust analytics coupled with AI and machine learning. AI is the future of customer relationship management, going beyond contact management and sales force automation to truly helping you sell. AI in CRM can guide you toward the next-best actions and provide smart talking points—specific to each customer opportunity. AI also delivers timely customer intelligence that helps you optimize customer experience (CX) across marketing, sales, and customer service. CRM vs. CX When customer relationship management first arrived on the scene, businesses would capture data but not know what to do with it. Today, CRM systems are integrated with AI, which helps interpret and predict what that data means. CRM AI capabilities are the foundation to using a 360-degree view of the customer that will start them on their way to becoming your customer. As these AI enhancements continue to evolve, CX will continue to improve—and in turn, customer expectations will continue to increase. Your business needs to fully understand your customers (and how they buy) to not only meet their expectations but to provide them with compelling experiences. This is the future of CX and should serve as your guide to selecting the best CRM solution. How CRM improves customer experience A complete customer view is necessary for business success and growth. Without a CRM system, you'll struggle to develop that much-needed 360-degree view of the customer that you need to: Personalize customer interactions Automate business processes (with appropriate CX integrations) Track all customer interactions
USER:
What are 5 goals of Customer Relationship Management Systems implementation within an enterprise?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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Use the source provided only.
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What is the history of taxes in the United States?
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Taxes in the United States: History, Fairness, and Current Political Issues by Brian Roach A GDAE Teaching Module on Social and Environmental Issues in Economics Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae Copyright © 2010 Global Development And Environment Institute, Tufts University. Copyright release is hereby granted for instructors to copy this module for instructional purposes. Students may also download the module directly from http://ase.tufts.edu/gdae. Comments and feedback from course use are welcomed: Tufts University Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae E-mail: [email protected] I. INTRODUCTION “The hardest thing in the world to understand is income tax!” – Albert Einstein Taxes are complicated. The U.S. federal tax code contains over three million words – about 6,000 pages. A casual browsing of the tax code’s table of contents offers a glimpse into the vast complexity of federal taxation. Entire sections of the tax code apply specifically to the taxation of vaccines (Sec. 4131-4132), shipowners' mutual protection and indemnity associations (Sec. 526), specially sweetened natural wines (Sec. 5385), and life insurance companies (Sec. 801-818). Annual changes to the tax code imply that taxes will continue to become more complex even as politicians tout tax simplification. Taxes levied by other jurisdictions, such as states and cities, add further complexity to taxation in the U.S. Americans spend billions of hours each year working on their taxes, not to mention the costs of accountants and tax preparers. Fortunately, one needn’t comprehend the imposing complexity of the tax code to understand the crucial role of taxes in American society. Taxation is an important, but commonly neglected, topic for students of economics, political science, and other disciplines. Tax policy has important economic consequences, both for the national economy and for particular groups within the economy. Tax policies are often designed with the intention of stimulating economic growth – although economists differ drastically about which policies are most effective at fostering growth. Taxes can create incentives promoting desirable behavior and disincentives for unwanted behavior. Taxation provides a means to redistribute economic resources towards those with low incomes or special needs. Taxes provide the revenue needed for critical public services such as social security, health care, national defense, and education. Taxation is as much of a political issue as an economic issue. Political leaders have used tax policy to promote their agendas by initiating various tax reforms: decreasing (or increasing) tax rates, changing the definition of taxable income, creating new taxes on specific products, etc. Of course, no one particularly wants to pay taxes. Specific groups, such as small-business owners, farmers, or retired individuals, exert significant political effort to reduce their share of the tax burden. The voluminous tax code is packed with rules that benefit a certain group of taxpayers while inevitably shifting more of the burden to others. Tax policy clearly reflects the expression of power in the U.S. – those without power or favor are left paying more in taxes while others reap the benefits of lower taxes because of their political influence. Broad attempts to reform the tax system have produced dramatic and sudden shifts in tax policy, generally motivated by political factors rather than sound economic theory. For example, the top marginal federal tax bracket on individual income in the U.S. dropped precipitously from 70% to 28% during the 1980s. Tax policy has clearly been used to promote political, as well as economic, agendas. This module is intended to provide a basic understanding of the economic, political, and social context of the entire U.S. tax system. When most people think about taxes, they 1 tend to think only of the federal income tax. However, looking solely at the federal income tax would miss several important issues. Perhaps most importantly, the federal income tax is not the largest tax bill to most Americans. We’ll see that the largest tax for most Americans is federal social insurance taxation. Also, the federal income tax is one of the most progressive taxes in the U.S. system. When all taxes are considered, the U.S. tax system is much less progressive. You may be surprised to find out how many taxes in the U.S. are actually regressive – hitting low-income households at a disproportionately high rate. This module is divided into three major sections. First, some basic terms will be defined and discussed, including tax progressivity and the differences between several types of taxes. Second, a brief overview of tax history in the United States will be presented. Third, data on tax trends will be used to illustrate the changing nature of taxation with a focus on the overall progressivity of the entire tax system. II. THE STRUCTURE OF TAXATION IN THE UNITED STATES Tax Progressivity The overall system of taxation in the United States is progressive. By a progressive tax system, we mean that the percentage of income an individual (or household) pays in taxes tends to increase with increasing income. Not only do those with higher incomes pay more in total taxes, they pay a higher rate of taxes. This is the essence of a progressive tax system. For example, a person making $100,000 in a year might pay 25% of their income in taxes ($25,000 in taxes), while someone with an income of $30,000 might only pay a 10% tax rate ($3,000 in taxes). A tax system may also be regressive or proportional. A regressive tax system is one where the proportion of income paid in taxes tends to decrease as one’s income increases. A proportional tax system simply means that everyone pays the same tax rate regardless of income. A particular tax system may display elements of more than one approach. Consider a hypothetical tax system where one pays a proportional, or flat 1 , rate on income below a certain dollar amount and then progressively increasing rates above that dollar amount. Also, within an overall tax system, some particular taxes might be progressive while other taxes are regressive. We’ll see later on that this the case in the United States. The Reasons for Progressive Taxation The overall tax system of the United States, and in most other countries, is progressive for a number of reasons. A progressive tax embodies the concept that those with high incomes should pay more of their income in taxes because of their greater ability to pay 1 This is not exactly the same concept embodied in current proposals for a “flat tax” in the U.S. These proposals would set just one tax rate but would exclude a given amount of income from taxation. Thus, the flat tax proposals would retain a small degree of progressivity. 2 without critical sacrifices. By paying a tax, any household must forego an equivalent amount of spending on goods, services, or investments. For a high-income household, these foregone opportunities might include a second home, an expensive vehicle, or a purchase of corporate stock. A low-income household, by comparison, might have to forego basic medical care, post-secondary education, or vehicle safety repairs. As income increases, the opportunity costs of paying taxes tend to be associated more with luxuries rather than basic necessities. The ability-to-pay principle recognizes that a flat (or regressive) tax rate would impose a larger burden, in terms of foregone necessities, on low-income households as compared to high-income households. A progressive tax system is also a mechanism to addresses economic inequalities in a society. To evaluate a tax system’s impact on inequality, one must consider both the distribution of taxes paid and the distribution of the benefits derived from tax revenue. If the benefits of programs funded by taxation primarily benefit low-income households while high-income households pay the majority of taxes, then the tax system effectively operates as a transfer mechanism. Increasing the progressivity of the tax system or altering the distribution of benefits allows greater redistribution of economic resources. We’ll mainly focus on tax payments in this module but you should also be aware that the benefits of public expenditures are not evenly distributed throughout society. 2 There is also an economic argument for a progressive tax system – it may yield a given level of public revenue with the least economic impact. To see why, consider how households with different levels of income would respond to a $100 tax cut. A lowincome household would tend to quickly spend the entire amount on needed goods and services – injecting $100 of increased demand into the economy. By comparison, a highincome household might only spend a fraction on goods and services, choosing to save or invest a portion of the money. The money that a high-income household saves or invests does not add to the overall level of effective demand in an economy. 3 In economic terms, we say that the marginal propensity to consume tends to decrease as income increases. So, by collecting proportionally more taxes from high-income households we tend to maintain a higher level of effective demand and more economic activity. Of course, one can posit that a tax system can become too progressive. Extremely high tax rates at high-income levels might create a significant disincentive that reduces the productive capacity of society. Very high taxes might limit the risks taken by entrepreneurs, stifling innovations and technological advances. The desire to “soak the rich” through an extremely progressive tax system might be viewed as unfair, and not just by the rich. In fact, this was a concern of the Constitutional framers – that a democratic majority would eventually impose unduly burdensome taxes on the wealthy minority. We’ll see that their concerns have proved groundless. Many critics of the current tax 2 The distribution of the benefits derived from public expenditures is, of course, more difficult to determine that the distribution of tax payments. The distribution of public assistance programs can be easily measured. However, the distribution of the benefits of scientific research support, business subsidies, public works, national defense, and other expenditures is a difficult research task. 3 Money saved or invested may, however, provide the financial capital necessary to increase the productive capacity of the economy. “Supply-side” economists stress the importance of investment by the wealthy as the key to economic growth. 3 system point to the contrary position – that the powerful minority have used their might to shift the tax burden away from themselves onto an immobilized and misinformed majority. Even if one could devise a tax system that is economically optimal (i.e., producing the highest overall level of economic growth), the topic of taxation encompasses ideals about equity and fairness. A society may be willing to sacrifice some degree of economic growth in exchange for a more equitable distribution of economic resources. This is not to say that economic growth must always be sacrificed with redistribution. In fact, analysis of the U.S. historical data finds that high levels of economic growth tend to be associated with periods of relatively equitable distribution of economic resources (Krugman, 2002). We now turn to differentiating between the different types of taxes levied in the U.S. We’ll first discuss several forms of federal taxation, roughly in order of the revenue they generate, and then consider taxation at the state and local levels. A final section will consider taxes that are generally not used in the U.S. but are important in other nations. Federal Income Taxes The federal income tax is the most visible, complicated, and debated tax in the U.S. The federal income tax was established with the ratification of the 16th Amendment to the U.S. Constitution in 1913. It is levied on wages and salaries as well as income from many other sources including interest, dividends, capital gains, self-employment income, alimony, and prizes. To understand the basic workings of federal income taxes, you need to comprehend only two major issues. First, all income is not taxable – there are important differences between “total income,” “adjusted gross income,” and “taxable income.” Second, you need to know the distinction between a person’s “effective tax rate” and “marginal tax rate.” Total income is simply the sum of income an individual or couple 4 receives from all sources. For most people, the largest portion of total income comes from wages or salaries. Many people also receive investment income from the three standard sources: interest, capital gains, and dividends. Self-employment income is also included in total income, along with other types of income such as alimony, farm income, and gambling winnings. The amount of federal taxes a person owes is not calculated based on total income. Instead, once total income is calculated, tax filers are allowed to subtract some expenses as non-taxable. To obtain adjusted gross income (AGI), certain out-of-pocket expenses made by a tax filer are subtracted from total income. These expenses include individual retirement account contributions, allowable moving expenses, student loan interest, tuition, and a few other expenses. AGI is important because much of the tax data presented by the IRS are sorted by AGI. 4 Married couples have the option of filing their federal taxes either jointly or separately. Children aged 14 or over with sufficient income ($7,700 in 2002) have to file their own federal income tax returns. 4 However, taxes are not calculated based on AGI either. Taxable income is basically AGI less deductions and exemptions. Deductions are either standard or itemized. The standard deduction is a fixed amount excluded from taxation – for the 2009 tax year the standard deduction was $5,700 for single individuals and $11,400 for married couples. Tax filers have the option of itemizing their deductions. To itemize, a tax filer adds up certain expenses made during the year including state taxes, real estate taxes, mortgage interest, gifts to charity, and major medical expenses. 5 If the itemized deductions exceed the standard deduction, then the itemized total is deducted instead. Exemptions are calculated based on the number of tax filers and dependents. A single tax filer with no dependent children can claim one exemption. A married couple with no children can claim two exemptions. Each dependent child counts as one more exemption. Additional exemptions are given for being age 65 or over or blind. In 2009, each exemption excluded a further $3,650 from taxation. 6 Taxable income is obtained by subtracting the deduction and exemption amounts from AGI. This is the amount a taxpayer actually pays taxes on. However, the amount of tax owed is not simply a multiple of taxable income and a single tax rate. The federal income tax system in the U.S. uses increasing marginal tax rates. This means that different tax rates apply on different portions of a person’s income. The concept is best illustrated with an example using the 2009 tax rates. For a single filer, the first $8,350 of taxable income (not total income or AGI) is taxed at a rate of 10%. Taxable income above $8,350 but less than $33,950 is taxed at a rate of 15%. Taxable income above $33,950 but less than $82,250 is taxed at a rate of 25%. Income above $82,250 is taxed at higher marginal rates – 28%, 33%, and 35%. Consider how we would calculate the taxes due for a single tax filer (let’s call her Susan) with no children and a total income of $35,000. Assume Susan contributed $3,000 to an individual retirement account and that this is her only allowable adjustment expense. Thus, her AGI is $32,000. She claims one exemption (herself) in the amount of $3,650 and the standard deduction of $5,700. Thus, Susan’s taxable income is $22,650. On the first $8,350 of taxable income she owes 10% in taxes, or $835. The tax rate on the rest of her income is 15% for a tax of $2,145, (($22,650 - $8,350) × 0.15). So, her total federal income tax bill is $2,980, ($835 + $2,145). Note that Susan’s taxable income is $12,350 less than her total income. While Susan paid a maximum tax rate of 15%, we can see that her effective tax rate is much lower. An effective tax rate can be calculated based on total income, AGI, or taxable income. Suppose we wish to calculate Susan’s effective tax rate based on her total income of $35,000. Given that her federal income tax is $2,980, her effective tax rate is only 8.5%, (($2,980/$35,000) × 100). If we based her effective tax rate on her AGI, it would be 9.3%, (($2,980/$32,000) × 100). 5 Note that some expenses, such as moving costs, are subtracted from total income to obtain AGI while other expenses, such as mortgage interest, are classified as deductions from AGI to obtain taxable income. 6 Those with high incomes (more than $125,100 for an individual) either have their exemption allowance either reduced or eliminated. 5 Social Insurance Taxes Taxes for federal social insurance programs, including Social Security, Medicaid, and Medicare, are taxed separately from income. Social insurance taxes are levied on salaries and wages, as well as income from self-employment. For those employed by others, these taxes are generally deducted directly from their paycheck. These deductions commonly appear as “FICA” taxes – a reference to the Federal Insurance Contributions Act. Self-employed individuals must pay their social insurance taxes when they file their federal income tax returns. Social insurance taxes are actually two separate taxes. The first is a tax of 12.4% of wages, which is primarily used to fund Social Security. Half of this tax is deducted from an employee’s paycheck while the employer is responsible for matching this contribution. The other is a tax of 2.9% for the Medicare program. Again, the employee and employer each pay half. Thus, social insurance taxes normally amount to a 7.65% deduction from an employee’s wage (6.2% + 1.45%). Self-employed individuals are responsible for paying the entire share, 15.3%, themselves. There is a very important difference between these two taxes. The Social Security tax is due only on the first $106,800 (in 2009) of income. On income above $106,800, no additional Social Security tax is paid. In other words, the maximum Social Security tax in 2009 that would be deducted from total wages is $6,622 ($106,800 × 0.062). The Medicare tax, however, is paid on all wages. Thus, the Medicare tax is truly a flat tax while the Social Security tax is a flat tax on the first $106,800 of income but then becomes a regressive tax when we consider income above this limit. Consider the impact of social insurance taxes on two individuals, one making a typical salary of $45,000 and another making $300,000. The typical worker would pay 7.65% on all income, or $3,443, in federal social insurance taxes. The high-income worker would pay the maximum Social Security contribution of $6,622 plus $4,350 for Medicare (1.45% of $300,000) for a total bill of $10,972. This works out to a 3.7% overall tax rate, or less than half the tax rate paid by the typical worker. As the high-income individual pays a lower rate of taxation, we see that social insurance taxes are regressive. Federal Corporate Taxes Corporations must file federal tax forms that are in many ways similar to the forms individuals complete. Corporate taxable income is defined as total revenues minus the cost of goods sold, wages and salaries, depreciation, repairs, interest paid, and other deductions. Thus corporations, like individuals, can take advantage of many deductions to reduce their taxable income. In fact, a corporation may have so many deductions that it actually ends up paying no tax at all or even receives a rebate check from the federal government. We’ll discuss this issue further later in the module. Corporate tax rates, like personal income tax rates, are progressive and calculated on a marginal basis. In 2009, the lowest corporate tax rate, applied to profits lower than 6 $50,000 was 15%. The highest marginal corporate tax rate, applied to profits between $100,000 and $335,000 was 39%. 7 As with individuals, the effective tax rate corporations pay is lower than their marginal tax rate. Federal Excise Taxes An excise tax is a tax on the production, sale, or use of a particular commodity. The federal government collects excise taxes from manufacturers and retailers for the production or sale of a surprising number of products including tires, telephone services, air travel, transportation fuels, alcohol, tobacco, and firearms. Unlike a sales tax, which is evident as an addition to the selling price of a product, excise taxes are normally incorporated into the price of a product. In most cases, consumers are not directly aware of the federal excise taxes they pay. However, every time you buy gas, make a phone call, fly in a commercial plane, or buy tobacco products, you are paying a federal excise tax. For example, the federal excise tax on gasoline as of 2009 was about 18 cents per gallon. Federal excise taxes are another example of a regressive tax. Lower-income households tend to spend a greater portion of their income on goods that are subject to federal excise taxes. This is particularly true for gasoline, tobacco, and alcohol products. Federal Estate and Gift Taxes The vast majority of Americans will never be affected by the federal estate or gift taxes. These taxes apply only to the wealthiest Americans. The estate tax is applied to transfers of large estates to beneficiaries. Similar to the federal income tax, there is an exemption amount that is not taxed. Only estates valued above the exemption amount are subject to the estate tax, and the tax only applies to the value of the estate above the exemption. For example, if the tax rate were 45% of the exemption amount was $2 million, then the tax on an estate valued at $3.5 million would be $675,000, ((3,500,000-2,000,000)*0.45). As of Fall 2010, the future of the estate tax is in limbo. Under the Economic Growth and Tax Relief Act of 2001, estate taxes rates were gradually reduced, and exemption rates gradually increased, over the period 2001-2009. In 2001, the exemption amount was $675,000 million and the tax rate was 55%. For the 2009 tax year, the exemption amount was $3.5 million and the tax rate was 45%. But for 2010, there is no estate tax at all! Then, in 2011, the tax is scheduled to be reinstated with an exemption of $1 million and a tax rate of 55%. The ongoing debate over the estate tax will be covered in more detail later in this module. The transfer of large gifts is also subject to federal taxation. The estate tax and gift tax are complementary because the gift tax essentially prevents people from giving away their estate to beneficiaries tax-free while they are still alive. In 2009, gifts under 7 For the highest profit bracket – profits above $18,333,333 – the marginal rate was 35%. 7 $13,000 were excluded from the tax. Similar to the federal income tax, the gift tax rates are marginal and progressive, with a maximum tax rate of 45%. The estate and gift taxes are the most progressive element of federal taxation. The estate tax is paid exclusively by those with considerable assets. Even further, the majority of all estate taxes are paid by a very small number of wealthy taxpayers. According to the Tax Policy Center, in 2009 the richest 0.1% of those subject to the estate tax pay 42% of the total estate tax revenue. (Tax Policy Center, 2010). State and Local Taxes Like the federal government, state governments also rely on tax revenues to fund public expenditures and transfer programs. Like the federal government, state governments rely on several different tax mechanisms including income taxes, excise taxes, and corporate taxes. Thus, much of the above discussion applies to the tax structures in place in most states. However, there are some important differences that deserve mention. First, nearly all states (45 as of 2010) have instituted some type of general sales tax. State sales tax rates range from 2.9% (Colorado) to 8.25% (California 8 ). A few states reduce the tax rate on certain goods considered to be necessities, such as food and prescription drugs. For example, the general sales tax in Illinois is 6.25% but most food and drug sales are taxed at only 1%. Other states with sales taxes exempt some necessities from taxation entirely. In most states, localities can charge a separate sales tax. While local sales taxes are generally lower than state sales taxes, there are exceptions. In New York the state sales tax is 4% but local sales taxes are often higher than 4%. Unlike income taxes, sales taxes tend to be quite regressive. The reason is that lowincome households tend to spend a larger share of their income on taxable items than high-income households. Consider gasoline – an item that tends to be a smaller share of total expenditures as income rises. An increase in the state taxes on gasoline impacts low-income households more than high-income households. Some states, such as Idaho and Kansas, offer low-income households a tax credit to compensate for the regressive nature of state sales taxes. Forty-one states levy an income tax. 9 Most of these states have several progressive tax brackets (up to 12 rates) similar to the federal income tax. However, state income taxes tend to be much less progressive than the federal income tax. Six states have only one income tax rate, meaning that their income tax approaches a flat tax. Several more states approach a flat tax because the top rate applies at a low income or the rates are relatively constant. For example, Maine’s two tax rates are 6.50% and 6.85%. 8 Local sales taxes are also levied in some municipalities in California, which can raise the total sales tax to as high as 10.75%. 9 Two other states, Tennessee and New Hampshire, levy no state income tax but do tax dividends and interest. 8 Another important distinction between the federal system of taxation and the taxes levied at state and local levels is use of property taxes. In fact, property taxes tend to be the largest revenue source for state and local governments. The primary property tax levied in the U.S. is a tax on real estate, including land, private residences, and commercial properties. Generally, the tax is an annual assessment calculated as a proportion of the value of the property, although the formulas used by localities differ significantly. Property taxes are commonly collected at a local level, but a share of property taxes is allocated for state purposes. Property taxes tend to be regressive, although less regressive than excise and sales taxes. The reason is that high-income households tend to have a lower proportion of their assets subjected to property taxes. While renters do not directly pay property taxes, most economists conclude that the costs of property taxes are largely passed on to renters in the form of higher rents. Composition of Tax Collections in the U.S. Table 1 presents government tax receipts, by tax source, for 2008 (the most recent year for which complete data were available). The table shows that federal taxes dominate the nation’s tax system with nearly 65% of all receipts. The largest federal tax is the income tax, followed closely by social insurance taxes. State and local tax systems are primarily dependent on sales, income, and property taxation. The data in Table 1 cover the major taxes utilized in the United States. To gain a broader perspective on taxation, see Box 1 for a summary of tax mechanisms that are major revenue sources for some countries but are currently non-existent or insignificant in the U.S. Table 1. 2008 U.S. Tax Receipts, by Source Source Federal Taxes Income Taxes Social Insurance Taxes Corporate Taxes Excise Taxes Estate Taxes Total, Federal Taxes State Taxes Sales Taxes Property Taxes Income Taxes Corporate Taxes Excise and Other Taxes Total, State Taxes Total, All Taxes Amount (Millions $) Percent of All Taxes 1,145,700 900,200 304,300 67,300 23,000 2,440,500 30.4% 23.9% 8.1% 1.8% 0.6% 64.7% 304,400 409,700 304,600 57,800 253,900 1,330,400 3,770,900 8.1% 10.9% 8.1% 1.5% 6.7% 35.3% 100.0% Source: U.S. Census Bureau (2010), except for federal estate tax data from Tax Policy Center (2008). 9 BOX 1. TAX ALTERNATIVES It is worthwhile to briefly consider tax types that are not currently important in the U.S. because these mechanisms are used in other countries or are central in various proposals to reform the U.S. tax system. We summarize five tax types here: 1. National sales tax. This would function similar to a state sales tax – as an addition to the retail price of certain products. A national sales tax would clearly be simpler and cheaper to administer than the current federal income tax. It would also encourage savings because, under most proposals, income that is not spent on taxable goods and services is not taxed. There are, however, two significant disadvantages to a national sales tax. First, it would create an incentive for black market exchanges to evade the tax. Second, it can be highly regressive – similar to the regressivity of state sales taxes. A national sales tax could be made less regressive, or even progressive, by providing rebates for low-income households. 2. National consumption tax. This is slightly different from a national sales tax. A household would pay the tax at the end of the year based on the value of its annual consumption of goods and services. Consumption can be calculated as total income less money not spent on goods and services (i.e., invested or saved). Again, a consumption tax would promote savings by exempting it from taxation. A consumption tax could also be designed to be progressive by taxing different levels of consumption at different marginal rates. 3. Value added tax. Most developed countries levy some form of value added tax (VAT). A VAT is levied at each stage in the production process of a product, collected from manufacturers according to the value added at each stage. Thus, the tax is not added to the retail price but incorporated into prices, similar to the way excise taxes become embedded into the price of products. Compared to a national sales tax, a VAT reduces the likelihood of black markets. 4. Wealth taxes. While the U.S. tax system includes local property taxes and, at least for a while, estate taxes, there is no tax on holdings of other assets such as corporate stocks, bonds, and personal property. Several European countries, including Sweden, Spain, and Switzerland, have instituted an annual wealth tax. A wealth tax could be very progressive by setting high rates and becoming effective only at significant wealth levels. 5. Environmental taxes. These are levied on goods and services in proportion to their environmental impact. One example is a carbon tax, which taxes products based on the emissions of carbon attributable to their production or consumption. The rationale of environmental taxation is that it encourages the use and development of goods and services with reduced environmental impacts. Like other taxes on goods and services, environmental taxes can be regressive – suggesting that environmental taxes need to be combined with other progressive taxes or rebates for low-income households. Among developed countries, the U.S. collects the smallest share of tax revenues from environmental taxes (OECD, 2010). 10 III. A BRIEF HISTORY OF TAXATION IN THE U.S. 10 Before the Federal Income Tax The tax mechanisms used during first 150 years or so of U.S. tax history bears little resemblance to the current system of taxation. First, the U.S. Constitution restricted “direct” taxation by the federal government – meaning taxes directly on individuals. Instead, the federal government relied on indirect taxes including taxes on imports (tariffs) and excise taxes. Tariffs were the major source of U.S. government receipts from the beginning of the nation up to the early 1900’s. For example, in 1800 custom duties comprised about 84% of government receipts (U.S. Census Bureau, 1960). Internal federal revenue collections (which exclude tariffs on imports) as recently as the early 20th century were primarily derived from excise taxes on alcohol. In 1900 over 60% of internal revenue collections came from alcohol excise taxes with another 20% from tobacco excise taxes. Another important difference is the scale of government taxation and expenditures relative to the entire economy. Government spending is currently a major portion of the total U.S. economy – in 2010 government expenditures and investment at all levels comprised about 20% of total economic output. In the late 1800s government expenditures were responsible for only about 2% of national output (earlier data on national output are not available). The role of government has become more prominent as a result of expansion of military activity and an increase in the provision of public services. Consequently an overall trend of increasing taxation is evident, although we’ll see that this trend has recently stabilized or reversed. The Constitutional framers were wary of a government’s power to tax. Taxation of the American Colonies by a distant and corrupt England was a driving force behind the American Revolution. Consequently, they believed in decentralized taxation and delegated most public revenue collection to localities, which relied primarily on property taxes. During peacetime the federal government was able to meet its expenses through relatively modest excise taxes and tariffs. During times of war, such as the War of 1812, federal taxes were temporarily raised to finance the war or pay down the ensuing debts. Once the financial crisis passed, taxes were reduced in response to public opposition to high tax rates. Like previous wars, the Civil War initiated an increase in both excise tax and tariff rates. Government revenue collections increased by a factor of seven between 1863 and 1866. Perhaps the most significant tax policy enacted during the Civil War was the institution of the first national income tax. Concerns about the legality of the tax, considering the Constitution’s prohibition of direct taxation, were muted during the national emergency. The income tax rates were low by modern standards – a maximum rate of 10% along with generous exemptions meant that only about 10% of households were subject to any income tax. Still, the income tax generated over 20% of federal revenues in 1865. After 10 The history of taxation is primarily derived from Brownlee (1996). 11 the war, few politicians favored the continuation of the income tax, and in 1872 it was allowed to expire. The impetus for the modern federal income tax rests not with a wartime emergency but with the Populist movement of the late 1800s. The internal tax system in place at the time, based primarily on excise taxes on alcohol and tobacco, was largely regressive. The Populists revived interest in an income tax as a means to introduce a progressive tax based on ability to pay. They saw it as a response to excessive monopoly profits and the concentration of wealth and power. In other words, the tax was not envisioned as a means to generate significant additional public revenue but as a vehicle of social justice. A federal income tax, with a large exemption of $4,000, was instituted in 1894 but the Supreme Court ruled it unconstitutional in 1895. Over the next couple of decades proposals were made for a constitutional amendment to establish a federal income tax. While these attempts were defeated, support for federal income taxation gradually increased. Eventually, in 1913 the 16th Amendment was ratified creating the legal basis for the federal income tax. While the initial income tax was progressive, it was less radical than many desired. In fact, many conservatives expressed guarded support for the measure to prevent a more significant tax. While the income tax was targeted towards the wealthy – in the first few years only about 2% of households paid any income tax – tax rates of only 1%-7% prevented it from generating significant revenues. “...virtually none of the income tax proponents within the government believed that the income tax would become a major, yet alone the dominant, permanent source of revenue within the consumption-based federal tax system.” (Brownlee, 1996, p. 45) These views were to quickly change as the nation required a dramatic increase in revenues to finance World War I. The Growth of Direct Taxation Rather than relying on increases in excise taxes and tariffs to finance World War I, the administration of Woodrow Wilson transformed the income tax framework laid down just a few years previously. Desiring both to raise additional revenue and enforce social justice, the top marginal rate increased dramatically from 7% in 1915 to 67% in 1917 (IRS, 2002). Corporate taxes also became an important revenue source, accounting for over one-quarter of internal revenue collections in 1917. In 1916 the estate tax was created, not necessarily to generate large revenues but as another instrument of progressive taxation. Unlike previous wars, much of the tax system laid down during World War I remained in place after the war. In the period from 1910 to 1925 tariffs fell from about half of government receipts to less than 15%. Meanwhile the new corporate and individual 12 income taxes made up nearly half of government receipts in the mid 1920s. The level of excise tax collections dropped significantly, especially during the years of Prohibition when alcohol excise taxes virtually disappeared. The Great Depression, of course, caused a significant decline in federal receipts. In 1932 tax rates were increased in an attempt to boost federal revenue. Franklin Roosevelt, in the years leading up to World War II, presented progressive taxation as a key element of the New Deal. However, the most significant measure enacted during this period was the creation of old-age insurance. Prior to national social insurance programs, poverty was the common state of the elderly (Skidmore, 1999). By the 1930s, several European countries had already instituted programs of social insurance. Germany was the first to establish old-age and survivors pensions in 1889 (Peterson, 1999). The Great Depression finally motivated policy makers in the U.S. to enact similar legislation. Rather than funding Social Security programs through increases in income, or other, taxes, the funding mechanism was a separate tax, split equally between employers and employees. All employees covered by the system 11 contributed and received benefits regardless of their income. This design was intended to protect the system from political attack. As everyone who pays into the system receives benefits, Social Security is not considered “welfare” that is allocated to only a segment of the population. Also, because Social Security is a separate tax, contributors view their old-age payments as entitlements and oppose attempts to weaken the program. This design has so far proved very successful – Social Security is often called the “third rail” of American politics (i.e., touch it and you die). World War II created yet another emergency situation requiring additional revenues. Similar to Woodrow Wilson during World War I, President Franklin Roosevelt sought to raise revenues primarily from higher taxes on corporations and high-income households. Roosevelt went so far as to state that: “In this time of grave national danger, when all excess income should go to win the war, no American citizen ought to have a net income, after he has paid his taxes, of more than $25,000.” (Brownlee, 1996, p. 91) Roosevelt was unable to obtain enough Congressional support to enact his most progressive proposals. The ensuing compromise did produce a more progressive federal income tax but it also became levied on more households. Personal exemptions were reduced by half between 1939 and 1942 – meaning the income tax reached well into the middle class for the first time. The taxable income subject to the highest marginal rate dropped from $5 million in 1941 down to $200,000 in 1942. Also, the top marginal tax rate reached a record high of 94% in 1944. Another change during World War II was withholding federal taxes from an employee’s paycheck rather than requiring payment of 11 While Social Security has expanded over the years to cover more employees, all workers are not currently covered by the system. For example, about one-quarter of state and local government employees are not included in the system (Peterson, 1999). 13 taxes due at the end of the year. These, as well as other, changes produced a dramatic shift in the structure of federal taxation: “Under the new tax system, the number of individual taxpayers grew from 3.9 million in 1939 to 42.6 million in 1945, and federal income tax collections over the period leaped from $2.2 billion to $35.1 billion. By the end of the war nearly 90 percent of the members of the labor force submitted income-tax returns, and about 60 percent of the labor force paid income taxes. … At the same time, the federal government came to dominate the nation’s revenue system. In 1940, federal income tax had accounted for only 16 percent of the taxes collected by all levels of government; by 1950 the federal income tax produced more than 51 percent of all collections. Installation of the new regime was the most dramatic shift in the nation’s tax policies since 1916.” (Brownlee, 1996, p. 96-97) As in the period after World War I, much of the new tax structure instituted during World War II remained in place after the war. Both major political parties expressed support for a progressive but broad income tax, relatively flat tax rates on corporate profits, and social insurance taxes that were basically regressive. Public support for the existing tax system was boosted by patriotic feelings and broad-based economic growth after the war. Changes to the tax system between the end of World War II and the 1980’s were generally minor. The Social Security tax occasionally increased as more people were receiving benefits. The initial tax rate of 2% (1% each for employers and employees) had increased to 6.13% by 1979. The Medicare and Medicaid programs were established in the 1960s. Across-the-board tax cuts in 1964 reduced marginal rates for both low- and high-income households (the top marginal rate fell from 91% in 1963 to 70% in 1965). Still, government continued to become a more significant portion of the entire economy in the decades after World War II. Total government expenditure and investment increased gradually from less than 18% of GDP in 1946 to over 22% by the mid 1970s. From the “Reagan Revolution” to the Bush Tax Cuts The general stasis of the federal tax system ended in the 1980s with the passage of several important tax reforms. Ronald Reagan was elected president in 1980 on a platform of smaller government and lower taxes. The Economic Recovery Tax Act of 1981 (ERTA) enacted the largest tax cut in American history 12 and inspired tax cutting by many other nations in the 1980s. The supply-side rationale behind ERTA’s sharp reduction in tax rates, particularly on high-income households and capital, was that greater incentives would motivate increased investment and economic activity. The ensuing economic growth and consequent tax revenue growth would, in theory, more than offset the revenue reductions as a result of the tax cuts. Thus, the theory was that tax cuts could actually produce an increase in federal revenues and address the growing federal budget deficit as well. ERTA phased in a reduction in the top tax rate from 70% to 50%, enacted several corporate tax cuts, and indexed many tax parameters to inflation (such as personal exemptions and deductions). 12 When measured in constant dollars (adjusted for inflation). 14 Analysis suggests that, in reality, ERTA resulted in the largest reduction in federal revenues of any tax bill since World War II (Tempalski, 1998). The federal budget deficit continued to grow. The very next year, in 1982, the largest peacetime tax increase was passed (Martin, 1991). The act repealed some of the more revenue-reducing provisions of ERTA, such as accelerated depreciation reductions for corporations, and closed several corporate loopholes in the tax code. Social Security reforms were enacted in 1983 that increased Social Security tax rates and initiated taxation of some benefits. Reagan continued to push for further tax reforms, leading to the Tax Reform Act of 1986 – considered to be the most comprehensive revision of the tax code since the 1950s (Petska and Strudler, 1999). This act reduced top income tax rates even further – from 50% in 1986 to 28% in 1988. Among many other changes, it also lowered the top corporate tax rate from 46% to 34%. Clearly, the “Reagan revolution” is an important era in U.S. tax history, but many people misinterpret it as a period where the size of the federal government was drastically reduced and taxes cut significantly. Despite the two major tax cuts during Reagan’s terms, federal revenue collections increased at nearly the same pace as national output (total federal revenues increased about 76% from 1980-1988 while GDP increased 83%). The actual changes were more evident in the distribution of federal revenues than their total level. The share of revenues from both individual and corporate taxation fell (by 9% and 16% respectively) while the portion from social insurance taxes increased by 38%. As the individual and corporate taxes are progressive, while social insurance taxes are regressive, the outcome was a decrease in the overall progressivity of the federal tax system. Specific changes within the individual income tax code exacerbated the decline in progressivity. The Reagan era failed to control the growing federal deficit. The annual budget deficits of the federal government tripled during the 1980s 13 (OMB, 2003). Partly to raise additional revenue to try to reduce deficits, the first President Bush reneged on his campaign promise of “no new taxes” and agreed to a compromise tax proposal in 1990 that raised the top marginal tax bracket to 31%. President Clinton reinstated additional progressivity in 1993 by creating the 36% and 39.6% individual tax brackets. In 1993, the corporate tax rate was increased slightly to 35%. These changes produced an increase in the progressivity of federal taxes. The most recent important tax legislation was the $1.35 trillion Bush tax cut passed in 2001. The major provisions of this act include lowering individual income tax rates across-the-board, scheduling repeal of the estate tax in 2010, and increasing the amount employees can contribute under various programs for retirement purposes. Many of the bill’s provisions are “back-loaded,” meaning the tax reductions are phased in over time with most of the tax reduction occurring in the future. For example, the top marginal bracket fell from 39.6% in 2001 to 38.6% in 2002 but eventually fell to 35.0% in 2006. 13 This is based on the “on-budget” calculations. The on-budget accounting excludes the Social Security trust fund as well as other minor balances. 15 The Bush tax cut reduced the overall progressiveness of the federal income tax as highincome taxpayers received a disproportionate share of the total cuts (CTJ, 2001). A somewhat smaller tax cut was passed in 2003 that, among other changes, accelerated scheduled tax rate decreases and lowered the maximum tax rate on capital gains and dividends. Most recently, the 2009 American Recovery and Reinvestment Act of 2009 instituted or expanded various tax credits such as a payroll tax credit of $400 per worker and an expanded tax credit for college tuition. IV. Summary Data of U.S. Tax History Until quite recently, tax collections have tended to increase over time; paralleling the increase in the size of the federal government. We see in Figure 1 that federal tax revenues have grown considerably during the 20th century, even after adjusting for inflation. A large increase in federal tax collections occurred during World War II, with relatively consistent growth after about 1960. However, notice occasional declines in federal tax revenues, due either to recessions or to major tax code changes. The growth Figure 1. Tax Collections, 1913-2009 (All values in 2009 dollars) 14 14 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. All data from various editions of the Statistical Abstract of the United States and U.S. Census Bureau (1960). 16 of state and local tax collections, by comparison, has been steadier with less fluctuation. The reason is that state and local tax revenues are derived primarily from property and sales taxes, which vary less than income (particularly corporate income) during business cycles. Another way to illustrate the growth of federal taxation is to measure it relative to national economic output. In Figure 2 we plot federal and state and local tax collections as a share of GDP. Three facts are evident from Figure 2. First, total tax collections have generally grown as a percentage of GDP over the 20th century. Again, the largest leap occurred during World War II, but some additional growth is evident after the war as well. The second fact is that federal tax revenues now substantially exceed state and local tax revenues. While World War II solidified the federal government as the primary tax collector in the U.S., note that this trend began prior to the war. Finally, note the decline in federal taxes as a percentage of GDP since 2000. This is a result of both economic recessions and declines in federal tax rates. In fact, federal taxes as a percentage of GDP were lower in 2009 than in any year since the 1940s. Figure 2. Tax Collections as a Percentage of GDP, 1913-2009 15 As federal revenues grew during the 20th century, the composition of taxation has changed considerably. We see in Figure 3 that at the beginning of the century federal taxation was dominated by excise taxes. Except for a revival of excise taxes during the Depression Era, their importance has generally diminished over time. Corporate taxes became the most significant source of federal revenues for the period 1918-1932. After a period of higher corporate taxes during World War II, corporate taxes have generally diminished in significance relative to other forms of federal taxation. Personal income 15 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. 17 taxes became the largest source of federal revenues in 1944 and have remained so. Since World War II, income taxes have consistently supplied between 40-50% of federal revenues. Since about 1950, social insurance taxes have increased their share of federal revenues from about 10% up to nearly 40%. In fact, social insurance taxes may soon exceed personal income taxes as the largest source of federal revenues. Figure 3. Composition of Federal Taxes, 1913-2009 The composition of state and local taxes, with its increased reliance on sales and property taxes, differs from the composition of federal taxes. Of course, each state has a different tax system – some states have no income and/or sales taxes, and tax rates can differ significantly across states. In this module, we combine tax data for all states rather than presenting a state-by-state analysis. Figure 4 presents the composition of state and local taxes over the period 1945-2009. The two major trends that are evident are a decline in the importance of property taxes and an increase in the importance of personal income taxes except for a recent reversal of these trends in the last few years. While property taxes were the primary source of state and local revenues until the 1970s, sales taxes became the major source of revenues until 2008, when property taxes again became the major revenue source. 18 Figure 4. Composition of State and Local Taxation, 1945-2009 V. THE DISTRIBUTION OF TAXES IN THE UNITED STATES Tax Incidence Analysis There are basically two ways to analyze how the tax burden is distributed. The easiest way is to measure the taxes directly paid by entities, such as households or businesses, classified according to criteria such as household income, business profit levels, etc. These data can be obtained directly from aggregate tax return data published by the IRS and from reports from other government agencies. This approach considers only who actually pays the tax to the government. Thus, it would allocate corporate taxes to corporations, excise taxes to manufacturers, sales taxes to consumers, etc. The second approach, called tax incidence analysis, is more complex yet more meaningful. While taxes are paid by various entities other than individuals, such as corporations, partnerships, and public service organizations, the burden of all taxes ultimately fall on people. The final incidence of taxation is contingent upon how a specific tax translates into changes in prices and changes in economic behavior among consumers and businesses: “Tax incidence is the study of who bears the economic burden of a tax. More generally, it is the positive analysis of the impact of taxes on the distribution of welfare within a society. It begins with the very basic insight that the person who 19 has the legal obligation to make a tax payment may not be the person whose welfare is reduced by the existence of the tax. The statutory incidence of a tax refers to the distribution of those legal tax payments – based on the statutory obligation to remit taxes to the government. ... Economic incidence differs from statutory incidence because of changes in behavior and consequent changes in equilibrium prices. Consumers buy less of a taxed product, so firms produce less and buy fewer inputs – which changes the net price or return to each input. Thus the job of the incidence analyst is to determine how those other prices change, and how those price changes affect different groups of individuals.” (Metcalf and Fullerton, 2002, p. 1) Tax incidence analysis has produced a number of generally accepted conclusions regarding the burden of different tax mechanisms. Remember, for example, that the payroll tax on paper is split equally between employer and employee: “So, who really pays the payroll tax? Is the payroll tax reflected in reduced profits for the employer or in reduced wages for the worker? ... there is generally universal agreement that the real burden of the tax falls almost entirely on the worker. Basically, an employer will only hire a worker if the cost to the employer of hiring that worker is no more than the value that worker can add. So, a worker is paid roughly what he or she adds to the value of production, minus the payroll tax; in effect, the whole tax is deducted from wages. ... to repeat, this is not a controversial view; it is the view of the vast majority of analysts...” (Krugman, 2001, p. 43) The most common assumption made regarding the allocation of corporate taxes is that the burden of these taxes falls almost exclusively on the owners of capital investments. Given the mobility of capital, the burden is not limited to owners of corporate capital but extends to owners of all capital. 16 This result is primarily a theoretical finding – in reality some portion of the corporate tax burden likely falls on workers (through lower wages) and consumers (through higher prices). Excise taxes, although directly paid by manufacturers, are generally attributed entirely to consumers according to their consumption patterns. 17 This result is based on an assumption of perfect competition in the affected industries. Real-world markets, however, are not perfectly competitive. The actual incidence of excise taxes will depend on the degree of competition in an industry. For example, imperfectly competitive industries with upward-sloping supply curves imply that prices increase by less than the tax and that a portion of excise taxes is borne by businesses. 18 16 See summary in Metcalf and Fullerton (2002). See CBO (2008). 18 See Fullerton and Metcalf (2002) for a summary of incidence assumptions and analyses for different types of taxes. 17 20 The burden of sales taxes is generally assumed to fall directly on consumers who buy the taxed goods and services. Again, this is a simplifying assumption – in reality some portion of sales taxes filters to corporate owners, other capital owners, and workers. Personal income taxes paid by households are directly attributed to those households paying the tax. Estate tax burdens fall on the heirs paying the tax. Finally, property tax burdens are generally assumed to fall on property owners although the burden can be passed on renters (some analysts attribute property taxes more broadly to owners of capital). So, for several types of tax mechanisms (personal income, sales, excise, and estate taxes), data on direct tax payments is analogous to tax incidence. However, for other taxes (payroll, corporate, and to a lesser extent property taxes) the direct data on tax payments will differ from the ultimate burden of the tax. Using Effective Tax Rate Data to Determine Tax Progressivity As mentioned before, a tax is progressive if the percentage of income a person pays for the tax increases as income increases. Thus, we can determine whether a tax is progressive or regressive by looking at a table showing the effective tax rates for a particular tax for people in different income categories. If effective tax rates increase (decrease) with increasing income, then the tax is progressive (regressive). Table 2 shows the percentage of income people in each adjusted gross income (AGI) category paid in federal income taxes in 2008, the most recent data available. We see that effective tax rates for the federal income tax tend to increase with increasing income (although not always). For taxpayers making less than $100,000 AGI per year, the Table 2. Distribution of Federal Income Taxes, 2008 AGI Category Percent of Returns 16.7 Average AGI $5,099 Average Income Taxes $177 Effective Income Tax Rate 3.5% 16.0 $14,927 $513 3.4% 13.0 $24,798 $1,421 5.7% 18.0 $39,126 $2,808 7.2% 13.5 $61,470 $5,246 8.5% 8.2 9.7 2.4 0.4 $86,421 $133,208 $285,735 $679,576 $8,037 $16,903 $55,984 $163,513 9.3% 12.7% 19.6% 24.1% 0.2 $3,349,101 $780,550 23.3% $1-$10,000 $10,000-$20,000 $20,000-$30,000 $30,000-$50,000 $50,000-$75,000 $75,000 - $100,000 $100,000-$200,000 $200,000-$500,000 $500,000$1,000,000 More than $1,000,000 21 effective federal income tax rate averages less than 10% of income. For those making more than $200,000 per year, the federal income tax averages more than 20% of income. The federal income tax is clearly progressive because those with higher incomes generally pay a larger share of their income for the tax. For a regressive tax, effective tax rates tend to decrease as income increases. If effective tax rates are constant at different income levels, then a tax is proportional. Looking at effective tax rates by income categories can normally determine whether a tax is progressive or regressive. However, there may be some cases where effective tax rates do not follow a consistent pattern across income levels. For example, suppose that effective taxes first increase but then decrease as we move up the income spectrum. Another limitation with data on effective tax rates is that this approach does not tell us the degree of progressivity or regressivity. We might not be able to determine whether one tax is more progressive than another or whether a particular tax becomes more or less progressive over time. Researchers have come up with several tax indices that measure the progressivity of a tax as a single number. These indices allow direct comparisons across different tax types and across time. The most common tax progressivity index is discussed in Box 2. Effective Tax Rates in the United States Data on the distribution of taxes in the U.S. are available from several sources. The government sources that publish data on tax distribution include the Internal Revenue Service (IRS), the Joint Committee on Taxation (JCT), the Congressional Budget Office (CBO), and the Office of Tax Analysis within the U.S. Treasury. The IRS data are the most detailed but focus on federal income and estate taxes. The IRS publishes data on corporate taxes but does not conduct tax incidence analysis. The JCT occasionally conducts tax incidence analyses but only on the federal income tax, payroll taxes, and federal excise taxes. The CBO adds the incidence of federal corporate taxes to their analyses but still omits the federal estate tax and all state and local taxes. The only source for tax incidence data for all taxes in the U.S. is Citizens for Tax Justice (CTJ), a non-profit organization. CTJ uses data from government sources but has developed its own models of tax incidence. Comparison of tax progressivity data from CTJ with data from the federal sources listed above indicates that their results are generally similar to the government’s results and not biased in either direction (Roach, 2003). 22 BOX 2. MEASURING TAX PROGRESSIVITY – THE SUITS INDEX The Suits Index, developed by Daniel Suits in the 1970s (Suits, 1977), calculates a single number that measures tax progressivity. The approach basically compares the cumulative share of income received by taxpayers, order from lowest to highest, to their cumulative share of taxes paid. For a progressive (regressive) tax, the share of taxes paid will tend to be less (more) than the share of income as we move up the income spectrum. Other tax progressivity indices have been developed but the Suits Index remains the most widely used approach (Anderson, et al., 2003). While the calculation details are not presented here, the Suits Index is a number ranging between –1 and +1. A negative Suits Index means that the tax is regressive while a positive index indicates a progressive tax (with a value of zero for a proportional tax). The Suits Index can be used to compare the degree of progressivity of different tax types as well as determine whether a tax becomes more or less progressive over time. The Suits Index has been used to estimate the progressivity of different tax types in the U.S. for 2007 (Roach, 2010). Table 2.1 shows that the U.S. tax system contains a mixture of progressive and regressive taxes. The federal estate tax is the most progressive tax while the federal corporate and income taxes are also progressive. On the other hand, federal excise taxes are the most regressive. Federal social insurance taxes and overall state and local taxes are also regressive. When all federal taxes are considered, the Suits Index of +0.18 indicates that federal taxation is progressive. The entire U.S. tax system is also progressive, but the recent Suits Indices of +0.05 and +0.06 are closer to a value of zero (a proportional tax) than just the federal tax system. Table 2.1. Suits Index Estimates of the U.S. Tax System, 2007, by Tax Type1 Tax Type Federal Income Federal Social Insurance Federal Excise Federal Corporate Federal Estate and Gift State and Local Total Federal All U.S. Taxes (2001 data) All U.S. Taxes (2004 data) All U.S. Taxes (2009 data) Suits Index +0.42 -0.20 -0.31 +0.51 +0.63 -0.12 +0.18 +0.09 +0.05 +0.06 __________________ 1 – The Suits Index for the federal estate and gift tax is based upon 2008 data. 23 Table 3 presents the tax distribution data from CTJ for 2009. We see that while the federal tax system is progressive, the state and local tax system is, on average, regressive. Overall, the tax system in the U.S. is progressive, although the rate of progressivity levels off at upper income levels and actually reverses at the highest income level in Table 3. Table 3. Effective Tax Rates, 2009 19 Effective Tax Rates Income Group Average Income Lowest 20% $12,400 Second 20% $25,000 Third 20% $40,000 Fourth 20% $66,000 Next 10% $100,000 Next 5% $141,000 Next 4% $245,000 Top 1% $1,328,000 ALL $68,900 Federal Taxes 3.6% 8.7% 13.9% 17.2% 19.0% 20.4% 21.3% 22.3% 18.0% State & Local Taxes 12.4% 11.8% 11.3% 11.3% 11.1% 10.8% 10.2% 8.4% 10.6% All Taxes 16.9% 20.5% 25.3% 28.5% 30.2% 31.2% 31.6% 30.8% 28.6% Tax Progressivity over Time Consistent data are generally not available to determine how the entire tax burden in the U.S. has shifted over time. Most analyses are limited to one, or a few, tax types. Further, interest groups can interpret the available data to support their particular agendas. For an illustration about how the same tax data can be used to support different claims, see Box 3. Analysis of tax progressivity over time indicates that the federal tax system is about as progressive now as it was in the late 1970s (Roach, 2010). The progressivity of the federal tax system declined during the early 1980s, rose in 1987 (the year following the passage of the Tax Reform Act of 1986), either remained stable or rose slightly up to the mid-200s, and decreased slightly since the mid-200s. Complete data on the distribution of state and local taxes are available from Citizens for Tax Justice for 1995, 2002, 2007, and 2009, with Suits Indices of -0.11, -0.07, -0.12, and -0.07 respectively. Thus the available data suggest no obvious overall trend in the regressivity of state and local taxes. The unavailability of consistent data on the distribution of state and local taxes makes determination of the trends in the overall U.S. 19 Data from CTJ, 2010. 24 tax system difficult to determine. As Table 2.1 indicated, total taxes declined in progressivity from 2001 to 2004, and then stayed about the same from 2004 to 2009. BOX 3. INTERPRETING TAX PROGRESSIVITY DATA Has the federal income tax burden on the very wealthy been increasing or decreasing in recent decades? Data published by the CBO reveals that the percent of federal income taxes paid by the highest-income taxpayers has increased steady over the past few decades. In 1979, the top 1% of taxpayers paid about 18.3% of all federal income taxes. In 2007, the top 1% of taxpayers paid over 39.5%. Clearly, these data suggest that the federal income tax has become much more progressive since 1979. However, these statistics represent an incomplete analysis. Specifically, it fails to consider how the proportion of income accruing to the top 1% has changed over the same time period. The increasing tax share paid by high-income taxpayers may be a function of an increase in income, rather than a change in the tax system. In other words, if the share of all income received by the top 1% increased, we would naturally expect that their share of taxes paid would also increase without any changes in the underlying progressivity of the tax system. Income statistics indicate that the share of income going to the top 1% of taxpayers has also increased significantly since 1979. The top 1% of taxpayers received less than 9.2% of income in 1979 but more than 19.4% in 2007. Based on this fact alone, we would expect the top 1% to be paying a greater share of all federal income taxes. So, has the federal income tax burden on the top 1% increased or decreased since 1979? We can combine the tax and income data for a more complete analysis. The share of income going to the top 1% increased by a factor of 2.1 between 1979 and 2007. Meanwhile, their share of taxes paid has increased by a factor of 2.2. This suggests that the share of taxes paid by the top 1% has risen by about as much as much as their share of income – indicating a relatively stable degree of tax progressivity in the federal income tax – a dramatically different conclusion had we only considered data on tax shares! 25 References Brownlee, W. Elliot. 1996. Federal Taxation in America. University of Cambridge Press: Cambridge. Chaptman, Dennis. 2003 “States' Budget Troubles Worsening, Report Finds,” Milwaukee Journal Sentinel, Feb. 5, 2003. Citizens for Tax Justice, Institute on Taxation & Economic Policy. 2003a. “Who Pays? A Distributional Analysis of the Tax Systems in All 50 States, 2nd Edition,” January 2003, http://www.itepnet.org/wp2000/text.pdf. Citizens for Tax Justice. 2010. “All Americans Pay Taxes,” April 15, 2010. http://www.ctj.org/pdf/taxday2010.pdf. Citizens for Tax Justice. 2003b. “Final Tax Plan Tilts Even More Towards Richest,” June 5, 2003 press release, http://www.ctj.org/pdf/sen0522.pdf. Citizens for Tax Justice. 2002. “White House Reveals Nation’s Biggest Problems: The Very Rich Don’t Have Enough Money & Workers Don’t Pay Enough in Taxes,” December 16, 2002 press release, http://www.ctj.org/pdf/flat1202.pdf. Citizens for Tax Justice. 2001. “Final Version of Bush Tax Plan Keeps High-End Tax Cuts, Adds to Long-Term Cost,” May 26, 2001 press release, http://www.ctj.org/html/gwbfinal.htm. Congressional Budget Office, “Effective Federal Tax Rates, 2005,” December 2008. Fullerton, Don, and Gilbert E. Metcalf, 2002. “Tax Incidence,” National Bureau of Economic Research Working Paper 8829. IRS (Internal Revenue Service). Various Years. Statistics of Income, Individual Income Tax Returns. Washington, D.C. IRS (Internal Revenue Service). 2002. “Personal Exemptions and Individual Income Tax Rates, 1913-2002.” Statistics of Income Bulletin Data Release, June 2002. Johnson, Charles M. 2002. “Finding their Balance?” Missoulian, December 8, 2002.Joint Committee on Taxation. 2001. “Updated Distribution of Certain Federal Tax Liabilities by Income Class for Calendar Year 2001,” JCX-65-01.Krugman, Paul. 2002. “For Richer,” The New York Times, October 20, 2002, section 6, page 62. Krugman, Paul. 2001. Fuzzy Math: The Essential Guide to the Bush Tax Cut Plan, W.W. Norton & Company: New York. 26 Martin, Cathie J. 1991. Shifting the Burden: The Struggle over Growth and Corporate Taxation. The University of Chicago Press: Chicago. Metcalf, Gilbert E. and Don Fullerton. 2002. “The Distribution of Tax Burdens: An Introduction,” National Bureau of Economic Research Working Paper 8978. OECD (Organisation for Economic Co-operation and Development). 2010. “More Information on Environmentally Related Taxes, Fees and Charges,” http://www2.oecd.org/ecoinst/queries/index.htm. OMB (Office of Management and Budget). 2003. “Historical Tables, Budget of the United States Government, Fiscal Year 2004.” Washington, D.C. Peterson, Wallace C. 1999. The Social Security Primer: What Every Citizen Should Know. M.E. Sharpe: Armonk, NY. Petska, Tom, and Mike Strudler. 1999. “The Distribution of Individual Income and Taxes: A New Look at an Old Issue.” Paper presented at the 1999 American Economics Association conference, January 3-5, 1999, New York, http://www.irs.gov/taxstats/article/0,,id=112309,00.html. Roach, Brian. 2010. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 10-07, December 2010. Roach, Brian. 2003. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 03-10, October 2003. Skidmore, Max J. 1999. Social Security and Its Enemies. Westview Press: Boulder, CO. Tax Policy Center. 2010. “Wealth Transfer Taxes: Who Pays the Estate Tax?” The Tax Policy Briefing Book, http://www.taxpolicycenter.org/briefing-book/keyelements/estate/who.cfm. Tax Policy Center. 2008. “Estate Tax Returns and Liability Under Current Law and Various Reform Proposals, 2008-2018,” Table T08-0264, October 20, 2008. Tempalski, Jerry. 1998. “Revenue Effects of Major Tax Bills.” Office of Tax Analysis Working Paper 81, December 1998. U.S. Census Bureau. 2003. “Historical Income Tables - Income Equality, Table IE-1,” http://www.census.gov/hhes/income/histinc/ie1.html. U.S. Census Bureau. 2010. The 2010 Statistical Abstract of the United States. Washington, D.C. 27 U.S. Census Bureau. Various Years. Statistical Abstract of the United States. Washington, D.C. U.S. Census Bureau. 1960. Historical Statistics of the United States, Colonial Times to 1957. Washington, D.C. 28 MODULE SUMMARY • The overall tax system in the United States is progressive, meaning that effective tax rates tend to increase as income increases. Progressive taxation is based on the view that higher-income taxpayers can pay higher tax rates without having to forego life’s basic necessities. Progressive taxation can also redress economic inequalities and collect a given level of revenue while maintaining the maximum level of economic growth. • The federal income tax is the most complicated and debated tax in the U.S. tax system. The federal income tax is progressive, with increasing marginal tax rates. Federal income taxes are calculated based on taxable income, which is less than total income because various exemptions and deductions are allowed. • The federal tax system in the U.S. also includes social insurance, corporate, excise, estate, and gifts taxes. Social insurance and excise taxes are regressive while corporate, estate, and gift taxes are progressive. The U.S. tax system also includes state and local taxes, primarily sales, income, and property taxes. • Nearly 70% of the taxes levied in the U.S. are collected at the federal level. The largest federal tax is the income tax, closely followed by social insurance taxes. The most significant non-federal tax is property taxes, followed by sales and income taxes. • Up until the early 1900s, the U.S. tax system primarily relied on excise taxes and tariffs for public revenues. The 16th Amendment, ratified in 1913, created the legal basis for federal income taxation, which up to that point had been prohibited under the Constitution. • Both World Wars led to significant changes in the structure and overall magnitude of taxes in the U.S. By the end of World War II, U.S. taxes were broad-based but progressive and dominated by federal-level taxation. • Tax cuts passed during the Reagan Administration in the 1980s were based on the theory that lower tax rates would spur economic growth, leading to a net increase in tax revenues. This theory was not supported by the evidence, eventually leading to tax increases in the early 1990s. The Bush tax cuts passed in 2001 and 2003 have made federal taxes less progressive. • Tax revenues in the U.S. increased dramatically during the 20th century, even after adjusting for inflation. When measured as a percentage of GDP, tax revenues grew significantly during World War II, grew at a slower pace afterwards, and leveled off recently at around 30% of GDP. 29 • Measuring the distribution of taxes requires tax incidence analysis, which determines the ultimate burden of a tax on taxpayers. Tax incidence analysis generally concludes that social insurance taxes fall on workers, corporate taxes fall on the owners of capital, excise taxes fall on consumers, and property taxes are passed on to renters. • Effective tax rates measured by income level can be used to determine whether a particular tax is progressive or regressive. While the U.S. tax system contains both progressive and regressive taxes, the overall system is progressive. Recent data suggest that federal taxes are becoming less progressive while state and local taxes are becoming more regressive. 30 DISCUSSION QUESTIONS 1. Comment on the following statement: “The fairest type of tax system is one in which everyone pays the same rate of taxation, regardless of income.” Do you agree or disagree with the statement? Why? 2. Suppose you could set the overall effective tax rates across different levels of income. What do you think should be the appropriate effective tax rates for a household of four (two adults and two children) with an income of $25,000? An income of $60,000? An income of $100,000? An income of $500,000? Is the system you devise more or less progressive than the tax system currently in place in the U.S.? How does your system compare with others in your class? 3. The U.S. tax system is currently comprised of many different types of taxes (income, social insurance, corporate, sales, property, etc.). What reasons could be given to support the use of many different tax types in a nation? Do you think that a nation’s tax system should be comprised of many different types of taxes or just one type of tax? If you had to choose just one type of tax to levy in a nation, what type of tax would you choose? Why? 4. Comment on the following statement: “As long as a tax cut reduces taxes for everyone, then everyone will be better off as a result of the tax cut.” Do you agree with this statement? Why or why not? 5. Using the Internet or other sources, look up information about basic structure of the tax system in place in a country other than the United States. What differences are evident in that country’s tax system? Do you think that country has a more or less progressive tax system? Which nation’s tax system is preferable to you? Why? 6. Locate a recent news story about a proposal for a change to the tax system, either at the federal or state level. Summarize the proposed change. Would the change increase or decrease tax progressivity? Who would benefit most from the proposal? Who would be hurt the most from the proposal? Do you support the proposal? Why or why not? 31 ADDITIONAL RESOURCES • All the federal government agencies that work on tax issues maintain web sites that provide tax data and reports. The IRS’s Statistics of Income Bulletins, published four times a year, can be found dating back to 1998 at http://www.irs.gov/taxstats/article/0,,id=117514,00.html. The SOI Bulletins provide data analysis of primarily individual and corporate taxes. Publications produced by the Joint Committee on Taxation can be found at http://www.jct.gov/publications.html. Publications by the Congressional Budget Office related to tax issues, going as far back as the 1970s, are available at http://www.cbo.gov/publications/bysubject.cfm?cat=33. Finally, tax analysis by the U.S. Treasury Department, only dating back to 2001, can be found at http://www.treasury.gov/resource-center/tax-policy/Pages/default.aspx. • A large amount of tax-related data is published annually in the Statistical Abstract of the United States. Each year’s edition includes a chapter on state and local government finances and another chapter on federal government finances. The Census Bureau has recently added select historical editions of the Statistical Abstract dating as far back as 1878, although online availability is more complete for the first half of the 20th century than the latter half of the century (see http://www.census.gov/compendia/statab). • Citizens for Tax Justice publishes many other tax analyses besides those referenced in this module. Their web site is www.ctj.org. Two other non-profit organizations that conduct tax analysis are the Tax Policy Center, a joint venture of the Urban Institute and Brookings Institution, and the Center for Budget and Policy Priorities. The Tax Policy Center (www.taxpolicycenter.org) publishes several reports each month on a wide range of tax issues, including distributional impacts and public budget implications. The CBPP (www.cbpp.org) research focuses on “fiscal policy and public programs that affect low- and moderate-income families and individuals.” Similar to the Tax Policy Center, the CBPP conducts distributional analyses of current tax proposals. • For an opposing view on tax issues, the Tax Foundation (www.taxfoundation.org) publishes tax analyses that generally support lower overall taxes and conclude that the distributional impacts of recent tax cuts are fair. A similar organization, with a more activist agenda, is Americans for Tax Reform (www.atr.org). 32 KEY TERMS AND CONCEPTS Ability-to-pay principle: the idea that higher-income households and individuals should pay higher tax rates than lower-income taxpayers because they are more able to bear the tax without foregoing life’s basic necessities. Adjusted gross income (AGI): the total income of a household or individual minus certain out-of-pocket expenses such as retirement account contributions, student loan interest, tuition, and other allowable subtractions. AGI is calculated on one’s federal tax return. Effective tax rate: one’s total taxes paid divided by some measure of income, such as total income, adjusted gross income, or taxable income. Environmental taxes: taxes levied on a good or service based on the environmental impact of its production or consumption. Estate taxes: taxes on the transfer of large estates to beneficiaries. Excise taxes: taxes on the production, sale, or use of a particular commodity. Exemptions: an amount excluded from taxation based on the number of tax filers and dependents. Gift taxes: taxes levied on large gifts; gift taxes are designed to prevent taxpayers from avoiding estate taxes by giving away their assets while alive. Itemized deductions: certain expenses excluded from federal taxation, including mortgage interest, state taxes, gifts to charity, real estate taxes, and major medical expenses. A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Marginal propensity to consume: the proportion of a marginal income increase that is spent on consumption goods and services, as opposed to invested or saved. Marginal tax rates: a tax system where a single taxpayer can pay different tax rates on successive portions of income. National consumption tax: a federal-level tax paid on the dollar amount a household or individual spends each year on goods and services, calculated using either a single tax rate or marginal tax rates. National sales tax: a federal-level tax paid on the purchase of certain goods and services, calculated as a percentage of the selling price. 33 Perfect competition: an idealized market structure characterized by many informed small firms with no market power selling undifferentiated products and with complete freedom to enter or exit the market. Progressive tax: a tax in which the percentage of income one pays for the tax increases as one’s income increases. Proportional tax: a tax in which the percentage of income one pays for the tax is constant regardless of income level. Regressive tax: a tax in which the percentage of income one pays for the tax decreases as one’s income increases. Social insurance taxes: taxes paid to support social insurance programs such as Social Security, Medicare, and Medicaid. Standard deduction: a fixed amount of income excluded from federal taxation based on filing status (single, married, etc.). A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Suits index: an index developed by Daniel Suits in the 1970s to measure the overall progressivity or regressivity of a tax. Tariffs: taxes levied on imported goods and services. Tax incidence analysis: estimating the ultimate financial burden of various taxes on different categories of households by tracing a tax’s impact on market prices and the economic behavior of consumers and businesses. Taxable income: the amount of income used as the basis for determine one’s income taxes. For federal income taxes, taxable income is equal to adjusted gross income (AGI) minus allowable deductions and exemptions. Total income: the total income a household or individual receives from all sources Value-added tax: a tax levied at each stage in the production process of a good or service. Wealth taxes: taxes levied on the value of one’s assets such as real estate, investments, cash, and other personal property. 34
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Use the source provided only. What is the history of taxes in the United States? Taxes in the United States: History, Fairness, and Current Political Issues by Brian Roach A GDAE Teaching Module on Social and Environmental Issues in Economics Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae Copyright © 2010 Global Development And Environment Institute, Tufts University. Copyright release is hereby granted for instructors to copy this module for instructional purposes. Students may also download the module directly from http://ase.tufts.edu/gdae. Comments and feedback from course use are welcomed: Tufts University Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae E-mail: [email protected] I. INTRODUCTION “The hardest thing in the world to understand is income tax!” – Albert Einstein Taxes are complicated. The U.S. federal tax code contains over three million words – about 6,000 pages. A casual browsing of the tax code’s table of contents offers a glimpse into the vast complexity of federal taxation. Entire sections of the tax code apply specifically to the taxation of vaccines (Sec. 4131-4132), shipowners' mutual protection and indemnity associations (Sec. 526), specially sweetened natural wines (Sec. 5385), and life insurance companies (Sec. 801-818). Annual changes to the tax code imply that taxes will continue to become more complex even as politicians tout tax simplification. Taxes levied by other jurisdictions, such as states and cities, add further complexity to taxation in the U.S. Americans spend billions of hours each year working on their taxes, not to mention the costs of accountants and tax preparers. Fortunately, one needn’t comprehend the imposing complexity of the tax code to understand the crucial role of taxes in American society. Taxation is an important, but commonly neglected, topic for students of economics, political science, and other disciplines. Tax policy has important economic consequences, both for the national economy and for particular groups within the economy. Tax policies are often designed with the intention of stimulating economic growth – although economists differ drastically about which policies are most effective at fostering growth. Taxes can create incentives promoting desirable behavior and disincentives for unwanted behavior. Taxation provides a means to redistribute economic resources towards those with low incomes or special needs. Taxes provide the revenue needed for critical public services such as social security, health care, national defense, and education. Taxation is as much of a political issue as an economic issue. Political leaders have used tax policy to promote their agendas by initiating various tax reforms: decreasing (or increasing) tax rates, changing the definition of taxable income, creating new taxes on specific products, etc. Of course, no one particularly wants to pay taxes. Specific groups, such as small-business owners, farmers, or retired individuals, exert significant political effort to reduce their share of the tax burden. The voluminous tax code is packed with rules that benefit a certain group of taxpayers while inevitably shifting more of the burden to others. Tax policy clearly reflects the expression of power in the U.S. – those without power or favor are left paying more in taxes while others reap the benefits of lower taxes because of their political influence. Broad attempts to reform the tax system have produced dramatic and sudden shifts in tax policy, generally motivated by political factors rather than sound economic theory. For example, the top marginal federal tax bracket on individual income in the U.S. dropped precipitously from 70% to 28% during the 1980s. Tax policy has clearly been used to promote political, as well as economic, agendas. This module is intended to provide a basic understanding of the economic, political, and social context of the entire U.S. tax system. When most people think about taxes, they 1 tend to think only of the federal income tax. However, looking solely at the federal income tax would miss several important issues. Perhaps most importantly, the federal income tax is not the largest tax bill to most Americans. We’ll see that the largest tax for most Americans is federal social insurance taxation. Also, the federal income tax is one of the most progressive taxes in the U.S. system. When all taxes are considered, the U.S. tax system is much less progressive. You may be surprised to find out how many taxes in the U.S. are actually regressive – hitting low-income households at a disproportionately high rate. This module is divided into three major sections. First, some basic terms will be defined and discussed, including tax progressivity and the differences between several types of taxes. Second, a brief overview of tax history in the United States will be presented. Third, data on tax trends will be used to illustrate the changing nature of taxation with a focus on the overall progressivity of the entire tax system. II. THE STRUCTURE OF TAXATION IN THE UNITED STATES Tax Progressivity The overall system of taxation in the United States is progressive. By a progressive tax system, we mean that the percentage of income an individual (or household) pays in taxes tends to increase with increasing income. Not only do those with higher incomes pay more in total taxes, they pay a higher rate of taxes. This is the essence of a progressive tax system. For example, a person making $100,000 in a year might pay 25% of their income in taxes ($25,000 in taxes), while someone with an income of $30,000 might only pay a 10% tax rate ($3,000 in taxes). A tax system may also be regressive or proportional. A regressive tax system is one where the proportion of income paid in taxes tends to decrease as one’s income increases. A proportional tax system simply means that everyone pays the same tax rate regardless of income. A particular tax system may display elements of more than one approach. Consider a hypothetical tax system where one pays a proportional, or flat 1 , rate on income below a certain dollar amount and then progressively increasing rates above that dollar amount. Also, within an overall tax system, some particular taxes might be progressive while other taxes are regressive. We’ll see later on that this the case in the United States. The Reasons for Progressive Taxation The overall tax system of the United States, and in most other countries, is progressive for a number of reasons. A progressive tax embodies the concept that those with high incomes should pay more of their income in taxes because of their greater ability to pay 1 This is not exactly the same concept embodied in current proposals for a “flat tax” in the U.S. These proposals would set just one tax rate but would exclude a given amount of income from taxation. Thus, the flat tax proposals would retain a small degree of progressivity. 2 without critical sacrifices. By paying a tax, any household must forego an equivalent amount of spending on goods, services, or investments. For a high-income household, these foregone opportunities might include a second home, an expensive vehicle, or a purchase of corporate stock. A low-income household, by comparison, might have to forego basic medical care, post-secondary education, or vehicle safety repairs. As income increases, the opportunity costs of paying taxes tend to be associated more with luxuries rather than basic necessities. The ability-to-pay principle recognizes that a flat (or regressive) tax rate would impose a larger burden, in terms of foregone necessities, on low-income households as compared to high-income households. A progressive tax system is also a mechanism to addresses economic inequalities in a society. To evaluate a tax system’s impact on inequality, one must consider both the distribution of taxes paid and the distribution of the benefits derived from tax revenue. If the benefits of programs funded by taxation primarily benefit low-income households while high-income households pay the majority of taxes, then the tax system effectively operates as a transfer mechanism. Increasing the progressivity of the tax system or altering the distribution of benefits allows greater redistribution of economic resources. We’ll mainly focus on tax payments in this module but you should also be aware that the benefits of public expenditures are not evenly distributed throughout society. 2 There is also an economic argument for a progressive tax system – it may yield a given level of public revenue with the least economic impact. To see why, consider how households with different levels of income would respond to a $100 tax cut. A lowincome household would tend to quickly spend the entire amount on needed goods and services – injecting $100 of increased demand into the economy. By comparison, a highincome household might only spend a fraction on goods and services, choosing to save or invest a portion of the money. The money that a high-income household saves or invests does not add to the overall level of effective demand in an economy. 3 In economic terms, we say that the marginal propensity to consume tends to decrease as income increases. So, by collecting proportionally more taxes from high-income households we tend to maintain a higher level of effective demand and more economic activity. Of course, one can posit that a tax system can become too progressive. Extremely high tax rates at high-income levels might create a significant disincentive that reduces the productive capacity of society. Very high taxes might limit the risks taken by entrepreneurs, stifling innovations and technological advances. The desire to “soak the rich” through an extremely progressive tax system might be viewed as unfair, and not just by the rich. In fact, this was a concern of the Constitutional framers – that a democratic majority would eventually impose unduly burdensome taxes on the wealthy minority. We’ll see that their concerns have proved groundless. Many critics of the current tax 2 The distribution of the benefits derived from public expenditures is, of course, more difficult to determine that the distribution of tax payments. The distribution of public assistance programs can be easily measured. However, the distribution of the benefits of scientific research support, business subsidies, public works, national defense, and other expenditures is a difficult research task. 3 Money saved or invested may, however, provide the financial capital necessary to increase the productive capacity of the economy. “Supply-side” economists stress the importance of investment by the wealthy as the key to economic growth. 3 system point to the contrary position – that the powerful minority have used their might to shift the tax burden away from themselves onto an immobilized and misinformed majority. Even if one could devise a tax system that is economically optimal (i.e., producing the highest overall level of economic growth), the topic of taxation encompasses ideals about equity and fairness. A society may be willing to sacrifice some degree of economic growth in exchange for a more equitable distribution of economic resources. This is not to say that economic growth must always be sacrificed with redistribution. In fact, analysis of the U.S. historical data finds that high levels of economic growth tend to be associated with periods of relatively equitable distribution of economic resources (Krugman, 2002). We now turn to differentiating between the different types of taxes levied in the U.S. We’ll first discuss several forms of federal taxation, roughly in order of the revenue they generate, and then consider taxation at the state and local levels. A final section will consider taxes that are generally not used in the U.S. but are important in other nations. Federal Income Taxes The federal income tax is the most visible, complicated, and debated tax in the U.S. The federal income tax was established with the ratification of the 16th Amendment to the U.S. Constitution in 1913. It is levied on wages and salaries as well as income from many other sources including interest, dividends, capital gains, self-employment income, alimony, and prizes. To understand the basic workings of federal income taxes, you need to comprehend only two major issues. First, all income is not taxable – there are important differences between “total income,” “adjusted gross income,” and “taxable income.” Second, you need to know the distinction between a person’s “effective tax rate” and “marginal tax rate.” Total income is simply the sum of income an individual or couple 4 receives from all sources. For most people, the largest portion of total income comes from wages or salaries. Many people also receive investment income from the three standard sources: interest, capital gains, and dividends. Self-employment income is also included in total income, along with other types of income such as alimony, farm income, and gambling winnings. The amount of federal taxes a person owes is not calculated based on total income. Instead, once total income is calculated, tax filers are allowed to subtract some expenses as non-taxable. To obtain adjusted gross income (AGI), certain out-of-pocket expenses made by a tax filer are subtracted from total income. These expenses include individual retirement account contributions, allowable moving expenses, student loan interest, tuition, and a few other expenses. AGI is important because much of the tax data presented by the IRS are sorted by AGI. 4 Married couples have the option of filing their federal taxes either jointly or separately. Children aged 14 or over with sufficient income ($7,700 in 2002) have to file their own federal income tax returns. 4 However, taxes are not calculated based on AGI either. Taxable income is basically AGI less deductions and exemptions. Deductions are either standard or itemized. The standard deduction is a fixed amount excluded from taxation – for the 2009 tax year the standard deduction was $5,700 for single individuals and $11,400 for married couples. Tax filers have the option of itemizing their deductions. To itemize, a tax filer adds up certain expenses made during the year including state taxes, real estate taxes, mortgage interest, gifts to charity, and major medical expenses. 5 If the itemized deductions exceed the standard deduction, then the itemized total is deducted instead. Exemptions are calculated based on the number of tax filers and dependents. A single tax filer with no dependent children can claim one exemption. A married couple with no children can claim two exemptions. Each dependent child counts as one more exemption. Additional exemptions are given for being age 65 or over or blind. In 2009, each exemption excluded a further $3,650 from taxation. 6 Taxable income is obtained by subtracting the deduction and exemption amounts from AGI. This is the amount a taxpayer actually pays taxes on. However, the amount of tax owed is not simply a multiple of taxable income and a single tax rate. The federal income tax system in the U.S. uses increasing marginal tax rates. This means that different tax rates apply on different portions of a person’s income. The concept is best illustrated with an example using the 2009 tax rates. For a single filer, the first $8,350 of taxable income (not total income or AGI) is taxed at a rate of 10%. Taxable income above $8,350 but less than $33,950 is taxed at a rate of 15%. Taxable income above $33,950 but less than $82,250 is taxed at a rate of 25%. Income above $82,250 is taxed at higher marginal rates – 28%, 33%, and 35%. Consider how we would calculate the taxes due for a single tax filer (let’s call her Susan) with no children and a total income of $35,000. Assume Susan contributed $3,000 to an individual retirement account and that this is her only allowable adjustment expense. Thus, her AGI is $32,000. She claims one exemption (herself) in the amount of $3,650 and the standard deduction of $5,700. Thus, Susan’s taxable income is $22,650. On the first $8,350 of taxable income she owes 10% in taxes, or $835. The tax rate on the rest of her income is 15% for a tax of $2,145, (($22,650 - $8,350) × 0.15). So, her total federal income tax bill is $2,980, ($835 + $2,145). Note that Susan’s taxable income is $12,350 less than her total income. While Susan paid a maximum tax rate of 15%, we can see that her effective tax rate is much lower. An effective tax rate can be calculated based on total income, AGI, or taxable income. Suppose we wish to calculate Susan’s effective tax rate based on her total income of $35,000. Given that her federal income tax is $2,980, her effective tax rate is only 8.5%, (($2,980/$35,000) × 100). If we based her effective tax rate on her AGI, it would be 9.3%, (($2,980/$32,000) × 100). 5 Note that some expenses, such as moving costs, are subtracted from total income to obtain AGI while other expenses, such as mortgage interest, are classified as deductions from AGI to obtain taxable income. 6 Those with high incomes (more than $125,100 for an individual) either have their exemption allowance either reduced or eliminated. 5 Social Insurance Taxes Taxes for federal social insurance programs, including Social Security, Medicaid, and Medicare, are taxed separately from income. Social insurance taxes are levied on salaries and wages, as well as income from self-employment. For those employed by others, these taxes are generally deducted directly from their paycheck. These deductions commonly appear as “FICA” taxes – a reference to the Federal Insurance Contributions Act. Self-employed individuals must pay their social insurance taxes when they file their federal income tax returns. Social insurance taxes are actually two separate taxes. The first is a tax of 12.4% of wages, which is primarily used to fund Social Security. Half of this tax is deducted from an employee’s paycheck while the employer is responsible for matching this contribution. The other is a tax of 2.9% for the Medicare program. Again, the employee and employer each pay half. Thus, social insurance taxes normally amount to a 7.65% deduction from an employee’s wage (6.2% + 1.45%). Self-employed individuals are responsible for paying the entire share, 15.3%, themselves. There is a very important difference between these two taxes. The Social Security tax is due only on the first $106,800 (in 2009) of income. On income above $106,800, no additional Social Security tax is paid. In other words, the maximum Social Security tax in 2009 that would be deducted from total wages is $6,622 ($106,800 × 0.062). The Medicare tax, however, is paid on all wages. Thus, the Medicare tax is truly a flat tax while the Social Security tax is a flat tax on the first $106,800 of income but then becomes a regressive tax when we consider income above this limit. Consider the impact of social insurance taxes on two individuals, one making a typical salary of $45,000 and another making $300,000. The typical worker would pay 7.65% on all income, or $3,443, in federal social insurance taxes. The high-income worker would pay the maximum Social Security contribution of $6,622 plus $4,350 for Medicare (1.45% of $300,000) for a total bill of $10,972. This works out to a 3.7% overall tax rate, or less than half the tax rate paid by the typical worker. As the high-income individual pays a lower rate of taxation, we see that social insurance taxes are regressive. Federal Corporate Taxes Corporations must file federal tax forms that are in many ways similar to the forms individuals complete. Corporate taxable income is defined as total revenues minus the cost of goods sold, wages and salaries, depreciation, repairs, interest paid, and other deductions. Thus corporations, like individuals, can take advantage of many deductions to reduce their taxable income. In fact, a corporation may have so many deductions that it actually ends up paying no tax at all or even receives a rebate check from the federal government. We’ll discuss this issue further later in the module. Corporate tax rates, like personal income tax rates, are progressive and calculated on a marginal basis. In 2009, the lowest corporate tax rate, applied to profits lower than 6 $50,000 was 15%. The highest marginal corporate tax rate, applied to profits between $100,000 and $335,000 was 39%. 7 As with individuals, the effective tax rate corporations pay is lower than their marginal tax rate. Federal Excise Taxes An excise tax is a tax on the production, sale, or use of a particular commodity. The federal government collects excise taxes from manufacturers and retailers for the production or sale of a surprising number of products including tires, telephone services, air travel, transportation fuels, alcohol, tobacco, and firearms. Unlike a sales tax, which is evident as an addition to the selling price of a product, excise taxes are normally incorporated into the price of a product. In most cases, consumers are not directly aware of the federal excise taxes they pay. However, every time you buy gas, make a phone call, fly in a commercial plane, or buy tobacco products, you are paying a federal excise tax. For example, the federal excise tax on gasoline as of 2009 was about 18 cents per gallon. Federal excise taxes are another example of a regressive tax. Lower-income households tend to spend a greater portion of their income on goods that are subject to federal excise taxes. This is particularly true for gasoline, tobacco, and alcohol products. Federal Estate and Gift Taxes The vast majority of Americans will never be affected by the federal estate or gift taxes. These taxes apply only to the wealthiest Americans. The estate tax is applied to transfers of large estates to beneficiaries. Similar to the federal income tax, there is an exemption amount that is not taxed. Only estates valued above the exemption amount are subject to the estate tax, and the tax only applies to the value of the estate above the exemption. For example, if the tax rate were 45% of the exemption amount was $2 million, then the tax on an estate valued at $3.5 million would be $675,000, ((3,500,000-2,000,000)*0.45). As of Fall 2010, the future of the estate tax is in limbo. Under the Economic Growth and Tax Relief Act of 2001, estate taxes rates were gradually reduced, and exemption rates gradually increased, over the period 2001-2009. In 2001, the exemption amount was $675,000 million and the tax rate was 55%. For the 2009 tax year, the exemption amount was $3.5 million and the tax rate was 45%. But for 2010, there is no estate tax at all! Then, in 2011, the tax is scheduled to be reinstated with an exemption of $1 million and a tax rate of 55%. The ongoing debate over the estate tax will be covered in more detail later in this module. The transfer of large gifts is also subject to federal taxation. The estate tax and gift tax are complementary because the gift tax essentially prevents people from giving away their estate to beneficiaries tax-free while they are still alive. In 2009, gifts under 7 For the highest profit bracket – profits above $18,333,333 – the marginal rate was 35%. 7 $13,000 were excluded from the tax. Similar to the federal income tax, the gift tax rates are marginal and progressive, with a maximum tax rate of 45%. The estate and gift taxes are the most progressive element of federal taxation. The estate tax is paid exclusively by those with considerable assets. Even further, the majority of all estate taxes are paid by a very small number of wealthy taxpayers. According to the Tax Policy Center, in 2009 the richest 0.1% of those subject to the estate tax pay 42% of the total estate tax revenue. (Tax Policy Center, 2010). State and Local Taxes Like the federal government, state governments also rely on tax revenues to fund public expenditures and transfer programs. Like the federal government, state governments rely on several different tax mechanisms including income taxes, excise taxes, and corporate taxes. Thus, much of the above discussion applies to the tax structures in place in most states. However, there are some important differences that deserve mention. First, nearly all states (45 as of 2010) have instituted some type of general sales tax. State sales tax rates range from 2.9% (Colorado) to 8.25% (California 8 ). A few states reduce the tax rate on certain goods considered to be necessities, such as food and prescription drugs. For example, the general sales tax in Illinois is 6.25% but most food and drug sales are taxed at only 1%. Other states with sales taxes exempt some necessities from taxation entirely. In most states, localities can charge a separate sales tax. While local sales taxes are generally lower than state sales taxes, there are exceptions. In New York the state sales tax is 4% but local sales taxes are often higher than 4%. Unlike income taxes, sales taxes tend to be quite regressive. The reason is that lowincome households tend to spend a larger share of their income on taxable items than high-income households. Consider gasoline – an item that tends to be a smaller share of total expenditures as income rises. An increase in the state taxes on gasoline impacts low-income households more than high-income households. Some states, such as Idaho and Kansas, offer low-income households a tax credit to compensate for the regressive nature of state sales taxes. Forty-one states levy an income tax. 9 Most of these states have several progressive tax brackets (up to 12 rates) similar to the federal income tax. However, state income taxes tend to be much less progressive than the federal income tax. Six states have only one income tax rate, meaning that their income tax approaches a flat tax. Several more states approach a flat tax because the top rate applies at a low income or the rates are relatively constant. For example, Maine’s two tax rates are 6.50% and 6.85%. 8 Local sales taxes are also levied in some municipalities in California, which can raise the total sales tax to as high as 10.75%. 9 Two other states, Tennessee and New Hampshire, levy no state income tax but do tax dividends and interest. 8 Another important distinction between the federal system of taxation and the taxes levied at state and local levels is use of property taxes. In fact, property taxes tend to be the largest revenue source for state and local governments. The primary property tax levied in the U.S. is a tax on real estate, including land, private residences, and commercial properties. Generally, the tax is an annual assessment calculated as a proportion of the value of the property, although the formulas used by localities differ significantly. Property taxes are commonly collected at a local level, but a share of property taxes is allocated for state purposes. Property taxes tend to be regressive, although less regressive than excise and sales taxes. The reason is that high-income households tend to have a lower proportion of their assets subjected to property taxes. While renters do not directly pay property taxes, most economists conclude that the costs of property taxes are largely passed on to renters in the form of higher rents. Composition of Tax Collections in the U.S. Table 1 presents government tax receipts, by tax source, for 2008 (the most recent year for which complete data were available). The table shows that federal taxes dominate the nation’s tax system with nearly 65% of all receipts. The largest federal tax is the income tax, followed closely by social insurance taxes. State and local tax systems are primarily dependent on sales, income, and property taxation. The data in Table 1 cover the major taxes utilized in the United States. To gain a broader perspective on taxation, see Box 1 for a summary of tax mechanisms that are major revenue sources for some countries but are currently non-existent or insignificant in the U.S. Table 1. 2008 U.S. Tax Receipts, by Source Source Federal Taxes Income Taxes Social Insurance Taxes Corporate Taxes Excise Taxes Estate Taxes Total, Federal Taxes State Taxes Sales Taxes Property Taxes Income Taxes Corporate Taxes Excise and Other Taxes Total, State Taxes Total, All Taxes Amount (Millions $) Percent of All Taxes 1,145,700 900,200 304,300 67,300 23,000 2,440,500 30.4% 23.9% 8.1% 1.8% 0.6% 64.7% 304,400 409,700 304,600 57,800 253,900 1,330,400 3,770,900 8.1% 10.9% 8.1% 1.5% 6.7% 35.3% 100.0% Source: U.S. Census Bureau (2010), except for federal estate tax data from Tax Policy Center (2008). 9 BOX 1. TAX ALTERNATIVES It is worthwhile to briefly consider tax types that are not currently important in the U.S. because these mechanisms are used in other countries or are central in various proposals to reform the U.S. tax system. We summarize five tax types here: 1. National sales tax. This would function similar to a state sales tax – as an addition to the retail price of certain products. A national sales tax would clearly be simpler and cheaper to administer than the current federal income tax. It would also encourage savings because, under most proposals, income that is not spent on taxable goods and services is not taxed. There are, however, two significant disadvantages to a national sales tax. First, it would create an incentive for black market exchanges to evade the tax. Second, it can be highly regressive – similar to the regressivity of state sales taxes. A national sales tax could be made less regressive, or even progressive, by providing rebates for low-income households. 2. National consumption tax. This is slightly different from a national sales tax. A household would pay the tax at the end of the year based on the value of its annual consumption of goods and services. Consumption can be calculated as total income less money not spent on goods and services (i.e., invested or saved). Again, a consumption tax would promote savings by exempting it from taxation. A consumption tax could also be designed to be progressive by taxing different levels of consumption at different marginal rates. 3. Value added tax. Most developed countries levy some form of value added tax (VAT). A VAT is levied at each stage in the production process of a product, collected from manufacturers according to the value added at each stage. Thus, the tax is not added to the retail price but incorporated into prices, similar to the way excise taxes become embedded into the price of products. Compared to a national sales tax, a VAT reduces the likelihood of black markets. 4. Wealth taxes. While the U.S. tax system includes local property taxes and, at least for a while, estate taxes, there is no tax on holdings of other assets such as corporate stocks, bonds, and personal property. Several European countries, including Sweden, Spain, and Switzerland, have instituted an annual wealth tax. A wealth tax could be very progressive by setting high rates and becoming effective only at significant wealth levels. 5. Environmental taxes. These are levied on goods and services in proportion to their environmental impact. One example is a carbon tax, which taxes products based on the emissions of carbon attributable to their production or consumption. The rationale of environmental taxation is that it encourages the use and development of goods and services with reduced environmental impacts. Like other taxes on goods and services, environmental taxes can be regressive – suggesting that environmental taxes need to be combined with other progressive taxes or rebates for low-income households. Among developed countries, the U.S. collects the smallest share of tax revenues from environmental taxes (OECD, 2010). 10 III. A BRIEF HISTORY OF TAXATION IN THE U.S. 10 Before the Federal Income Tax The tax mechanisms used during first 150 years or so of U.S. tax history bears little resemblance to the current system of taxation. First, the U.S. Constitution restricted “direct” taxation by the federal government – meaning taxes directly on individuals. Instead, the federal government relied on indirect taxes including taxes on imports (tariffs) and excise taxes. Tariffs were the major source of U.S. government receipts from the beginning of the nation up to the early 1900’s. For example, in 1800 custom duties comprised about 84% of government receipts (U.S. Census Bureau, 1960). Internal federal revenue collections (which exclude tariffs on imports) as recently as the early 20th century were primarily derived from excise taxes on alcohol. In 1900 over 60% of internal revenue collections came from alcohol excise taxes with another 20% from tobacco excise taxes. Another important difference is the scale of government taxation and expenditures relative to the entire economy. Government spending is currently a major portion of the total U.S. economy – in 2010 government expenditures and investment at all levels comprised about 20% of total economic output. In the late 1800s government expenditures were responsible for only about 2% of national output (earlier data on national output are not available). The role of government has become more prominent as a result of expansion of military activity and an increase in the provision of public services. Consequently an overall trend of increasing taxation is evident, although we’ll see that this trend has recently stabilized or reversed. The Constitutional framers were wary of a government’s power to tax. Taxation of the American Colonies by a distant and corrupt England was a driving force behind the American Revolution. Consequently, they believed in decentralized taxation and delegated most public revenue collection to localities, which relied primarily on property taxes. During peacetime the federal government was able to meet its expenses through relatively modest excise taxes and tariffs. During times of war, such as the War of 1812, federal taxes were temporarily raised to finance the war or pay down the ensuing debts. Once the financial crisis passed, taxes were reduced in response to public opposition to high tax rates. Like previous wars, the Civil War initiated an increase in both excise tax and tariff rates. Government revenue collections increased by a factor of seven between 1863 and 1866. Perhaps the most significant tax policy enacted during the Civil War was the institution of the first national income tax. Concerns about the legality of the tax, considering the Constitution’s prohibition of direct taxation, were muted during the national emergency. The income tax rates were low by modern standards – a maximum rate of 10% along with generous exemptions meant that only about 10% of households were subject to any income tax. Still, the income tax generated over 20% of federal revenues in 1865. After 10 The history of taxation is primarily derived from Brownlee (1996). 11 the war, few politicians favored the continuation of the income tax, and in 1872 it was allowed to expire. The impetus for the modern federal income tax rests not with a wartime emergency but with the Populist movement of the late 1800s. The internal tax system in place at the time, based primarily on excise taxes on alcohol and tobacco, was largely regressive. The Populists revived interest in an income tax as a means to introduce a progressive tax based on ability to pay. They saw it as a response to excessive monopoly profits and the concentration of wealth and power. In other words, the tax was not envisioned as a means to generate significant additional public revenue but as a vehicle of social justice. A federal income tax, with a large exemption of $4,000, was instituted in 1894 but the Supreme Court ruled it unconstitutional in 1895. Over the next couple of decades proposals were made for a constitutional amendment to establish a federal income tax. While these attempts were defeated, support for federal income taxation gradually increased. Eventually, in 1913 the 16th Amendment was ratified creating the legal basis for the federal income tax. While the initial income tax was progressive, it was less radical than many desired. In fact, many conservatives expressed guarded support for the measure to prevent a more significant tax. While the income tax was targeted towards the wealthy – in the first few years only about 2% of households paid any income tax – tax rates of only 1%-7% prevented it from generating significant revenues. “...virtually none of the income tax proponents within the government believed that the income tax would become a major, yet alone the dominant, permanent source of revenue within the consumption-based federal tax system.” (Brownlee, 1996, p. 45) These views were to quickly change as the nation required a dramatic increase in revenues to finance World War I. The Growth of Direct Taxation Rather than relying on increases in excise taxes and tariffs to finance World War I, the administration of Woodrow Wilson transformed the income tax framework laid down just a few years previously. Desiring both to raise additional revenue and enforce social justice, the top marginal rate increased dramatically from 7% in 1915 to 67% in 1917 (IRS, 2002). Corporate taxes also became an important revenue source, accounting for over one-quarter of internal revenue collections in 1917. In 1916 the estate tax was created, not necessarily to generate large revenues but as another instrument of progressive taxation. Unlike previous wars, much of the tax system laid down during World War I remained in place after the war. In the period from 1910 to 1925 tariffs fell from about half of government receipts to less than 15%. Meanwhile the new corporate and individual 12 income taxes made up nearly half of government receipts in the mid 1920s. The level of excise tax collections dropped significantly, especially during the years of Prohibition when alcohol excise taxes virtually disappeared. The Great Depression, of course, caused a significant decline in federal receipts. In 1932 tax rates were increased in an attempt to boost federal revenue. Franklin Roosevelt, in the years leading up to World War II, presented progressive taxation as a key element of the New Deal. However, the most significant measure enacted during this period was the creation of old-age insurance. Prior to national social insurance programs, poverty was the common state of the elderly (Skidmore, 1999). By the 1930s, several European countries had already instituted programs of social insurance. Germany was the first to establish old-age and survivors pensions in 1889 (Peterson, 1999). The Great Depression finally motivated policy makers in the U.S. to enact similar legislation. Rather than funding Social Security programs through increases in income, or other, taxes, the funding mechanism was a separate tax, split equally between employers and employees. All employees covered by the system 11 contributed and received benefits regardless of their income. This design was intended to protect the system from political attack. As everyone who pays into the system receives benefits, Social Security is not considered “welfare” that is allocated to only a segment of the population. Also, because Social Security is a separate tax, contributors view their old-age payments as entitlements and oppose attempts to weaken the program. This design has so far proved very successful – Social Security is often called the “third rail” of American politics (i.e., touch it and you die). World War II created yet another emergency situation requiring additional revenues. Similar to Woodrow Wilson during World War I, President Franklin Roosevelt sought to raise revenues primarily from higher taxes on corporations and high-income households. Roosevelt went so far as to state that: “In this time of grave national danger, when all excess income should go to win the war, no American citizen ought to have a net income, after he has paid his taxes, of more than $25,000.” (Brownlee, 1996, p. 91) Roosevelt was unable to obtain enough Congressional support to enact his most progressive proposals. The ensuing compromise did produce a more progressive federal income tax but it also became levied on more households. Personal exemptions were reduced by half between 1939 and 1942 – meaning the income tax reached well into the middle class for the first time. The taxable income subject to the highest marginal rate dropped from $5 million in 1941 down to $200,000 in 1942. Also, the top marginal tax rate reached a record high of 94% in 1944. Another change during World War II was withholding federal taxes from an employee’s paycheck rather than requiring payment of 11 While Social Security has expanded over the years to cover more employees, all workers are not currently covered by the system. For example, about one-quarter of state and local government employees are not included in the system (Peterson, 1999). 13 taxes due at the end of the year. These, as well as other, changes produced a dramatic shift in the structure of federal taxation: “Under the new tax system, the number of individual taxpayers grew from 3.9 million in 1939 to 42.6 million in 1945, and federal income tax collections over the period leaped from $2.2 billion to $35.1 billion. By the end of the war nearly 90 percent of the members of the labor force submitted income-tax returns, and about 60 percent of the labor force paid income taxes. … At the same time, the federal government came to dominate the nation’s revenue system. In 1940, federal income tax had accounted for only 16 percent of the taxes collected by all levels of government; by 1950 the federal income tax produced more than 51 percent of all collections. Installation of the new regime was the most dramatic shift in the nation’s tax policies since 1916.” (Brownlee, 1996, p. 96-97) As in the period after World War I, much of the new tax structure instituted during World War II remained in place after the war. Both major political parties expressed support for a progressive but broad income tax, relatively flat tax rates on corporate profits, and social insurance taxes that were basically regressive. Public support for the existing tax system was boosted by patriotic feelings and broad-based economic growth after the war. Changes to the tax system between the end of World War II and the 1980’s were generally minor. The Social Security tax occasionally increased as more people were receiving benefits. The initial tax rate of 2% (1% each for employers and employees) had increased to 6.13% by 1979. The Medicare and Medicaid programs were established in the 1960s. Across-the-board tax cuts in 1964 reduced marginal rates for both low- and high-income households (the top marginal rate fell from 91% in 1963 to 70% in 1965). Still, government continued to become a more significant portion of the entire economy in the decades after World War II. Total government expenditure and investment increased gradually from less than 18% of GDP in 1946 to over 22% by the mid 1970s. From the “Reagan Revolution” to the Bush Tax Cuts The general stasis of the federal tax system ended in the 1980s with the passage of several important tax reforms. Ronald Reagan was elected president in 1980 on a platform of smaller government and lower taxes. The Economic Recovery Tax Act of 1981 (ERTA) enacted the largest tax cut in American history 12 and inspired tax cutting by many other nations in the 1980s. The supply-side rationale behind ERTA’s sharp reduction in tax rates, particularly on high-income households and capital, was that greater incentives would motivate increased investment and economic activity. The ensuing economic growth and consequent tax revenue growth would, in theory, more than offset the revenue reductions as a result of the tax cuts. Thus, the theory was that tax cuts could actually produce an increase in federal revenues and address the growing federal budget deficit as well. ERTA phased in a reduction in the top tax rate from 70% to 50%, enacted several corporate tax cuts, and indexed many tax parameters to inflation (such as personal exemptions and deductions). 12 When measured in constant dollars (adjusted for inflation). 14 Analysis suggests that, in reality, ERTA resulted in the largest reduction in federal revenues of any tax bill since World War II (Tempalski, 1998). The federal budget deficit continued to grow. The very next year, in 1982, the largest peacetime tax increase was passed (Martin, 1991). The act repealed some of the more revenue-reducing provisions of ERTA, such as accelerated depreciation reductions for corporations, and closed several corporate loopholes in the tax code. Social Security reforms were enacted in 1983 that increased Social Security tax rates and initiated taxation of some benefits. Reagan continued to push for further tax reforms, leading to the Tax Reform Act of 1986 – considered to be the most comprehensive revision of the tax code since the 1950s (Petska and Strudler, 1999). This act reduced top income tax rates even further – from 50% in 1986 to 28% in 1988. Among many other changes, it also lowered the top corporate tax rate from 46% to 34%. Clearly, the “Reagan revolution” is an important era in U.S. tax history, but many people misinterpret it as a period where the size of the federal government was drastically reduced and taxes cut significantly. Despite the two major tax cuts during Reagan’s terms, federal revenue collections increased at nearly the same pace as national output (total federal revenues increased about 76% from 1980-1988 while GDP increased 83%). The actual changes were more evident in the distribution of federal revenues than their total level. The share of revenues from both individual and corporate taxation fell (by 9% and 16% respectively) while the portion from social insurance taxes increased by 38%. As the individual and corporate taxes are progressive, while social insurance taxes are regressive, the outcome was a decrease in the overall progressivity of the federal tax system. Specific changes within the individual income tax code exacerbated the decline in progressivity. The Reagan era failed to control the growing federal deficit. The annual budget deficits of the federal government tripled during the 1980s 13 (OMB, 2003). Partly to raise additional revenue to try to reduce deficits, the first President Bush reneged on his campaign promise of “no new taxes” and agreed to a compromise tax proposal in 1990 that raised the top marginal tax bracket to 31%. President Clinton reinstated additional progressivity in 1993 by creating the 36% and 39.6% individual tax brackets. In 1993, the corporate tax rate was increased slightly to 35%. These changes produced an increase in the progressivity of federal taxes. The most recent important tax legislation was the $1.35 trillion Bush tax cut passed in 2001. The major provisions of this act include lowering individual income tax rates across-the-board, scheduling repeal of the estate tax in 2010, and increasing the amount employees can contribute under various programs for retirement purposes. Many of the bill’s provisions are “back-loaded,” meaning the tax reductions are phased in over time with most of the tax reduction occurring in the future. For example, the top marginal bracket fell from 39.6% in 2001 to 38.6% in 2002 but eventually fell to 35.0% in 2006. 13 This is based on the “on-budget” calculations. The on-budget accounting excludes the Social Security trust fund as well as other minor balances. 15 The Bush tax cut reduced the overall progressiveness of the federal income tax as highincome taxpayers received a disproportionate share of the total cuts (CTJ, 2001). A somewhat smaller tax cut was passed in 2003 that, among other changes, accelerated scheduled tax rate decreases and lowered the maximum tax rate on capital gains and dividends. Most recently, the 2009 American Recovery and Reinvestment Act of 2009 instituted or expanded various tax credits such as a payroll tax credit of $400 per worker and an expanded tax credit for college tuition. IV. Summary Data of U.S. Tax History Until quite recently, tax collections have tended to increase over time; paralleling the increase in the size of the federal government. We see in Figure 1 that federal tax revenues have grown considerably during the 20th century, even after adjusting for inflation. A large increase in federal tax collections occurred during World War II, with relatively consistent growth after about 1960. However, notice occasional declines in federal tax revenues, due either to recessions or to major tax code changes. The growth Figure 1. Tax Collections, 1913-2009 (All values in 2009 dollars) 14 14 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. All data from various editions of the Statistical Abstract of the United States and U.S. Census Bureau (1960). 16 of state and local tax collections, by comparison, has been steadier with less fluctuation. The reason is that state and local tax revenues are derived primarily from property and sales taxes, which vary less than income (particularly corporate income) during business cycles. Another way to illustrate the growth of federal taxation is to measure it relative to national economic output. In Figure 2 we plot federal and state and local tax collections as a share of GDP. Three facts are evident from Figure 2. First, total tax collections have generally grown as a percentage of GDP over the 20th century. Again, the largest leap occurred during World War II, but some additional growth is evident after the war as well. The second fact is that federal tax revenues now substantially exceed state and local tax revenues. While World War II solidified the federal government as the primary tax collector in the U.S., note that this trend began prior to the war. Finally, note the decline in federal taxes as a percentage of GDP since 2000. This is a result of both economic recessions and declines in federal tax rates. In fact, federal taxes as a percentage of GDP were lower in 2009 than in any year since the 1940s. Figure 2. Tax Collections as a Percentage of GDP, 1913-2009 15 As federal revenues grew during the 20th century, the composition of taxation has changed considerably. We see in Figure 3 that at the beginning of the century federal taxation was dominated by excise taxes. Except for a revival of excise taxes during the Depression Era, their importance has generally diminished over time. Corporate taxes became the most significant source of federal revenues for the period 1918-1932. After a period of higher corporate taxes during World War II, corporate taxes have generally diminished in significance relative to other forms of federal taxation. Personal income 15 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. 17 taxes became the largest source of federal revenues in 1944 and have remained so. Since World War II, income taxes have consistently supplied between 40-50% of federal revenues. Since about 1950, social insurance taxes have increased their share of federal revenues from about 10% up to nearly 40%. In fact, social insurance taxes may soon exceed personal income taxes as the largest source of federal revenues. Figure 3. Composition of Federal Taxes, 1913-2009 The composition of state and local taxes, with its increased reliance on sales and property taxes, differs from the composition of federal taxes. Of course, each state has a different tax system – some states have no income and/or sales taxes, and tax rates can differ significantly across states. In this module, we combine tax data for all states rather than presenting a state-by-state analysis. Figure 4 presents the composition of state and local taxes over the period 1945-2009. The two major trends that are evident are a decline in the importance of property taxes and an increase in the importance of personal income taxes except for a recent reversal of these trends in the last few years. While property taxes were the primary source of state and local revenues until the 1970s, sales taxes became the major source of revenues until 2008, when property taxes again became the major revenue source. 18 Figure 4. Composition of State and Local Taxation, 1945-2009 V. THE DISTRIBUTION OF TAXES IN THE UNITED STATES Tax Incidence Analysis There are basically two ways to analyze how the tax burden is distributed. The easiest way is to measure the taxes directly paid by entities, such as households or businesses, classified according to criteria such as household income, business profit levels, etc. These data can be obtained directly from aggregate tax return data published by the IRS and from reports from other government agencies. This approach considers only who actually pays the tax to the government. Thus, it would allocate corporate taxes to corporations, excise taxes to manufacturers, sales taxes to consumers, etc. The second approach, called tax incidence analysis, is more complex yet more meaningful. While taxes are paid by various entities other than individuals, such as corporations, partnerships, and public service organizations, the burden of all taxes ultimately fall on people. The final incidence of taxation is contingent upon how a specific tax translates into changes in prices and changes in economic behavior among consumers and businesses: “Tax incidence is the study of who bears the economic burden of a tax. More generally, it is the positive analysis of the impact of taxes on the distribution of welfare within a society. It begins with the very basic insight that the person who 19 has the legal obligation to make a tax payment may not be the person whose welfare is reduced by the existence of the tax. The statutory incidence of a tax refers to the distribution of those legal tax payments – based on the statutory obligation to remit taxes to the government. ... Economic incidence differs from statutory incidence because of changes in behavior and consequent changes in equilibrium prices. Consumers buy less of a taxed product, so firms produce less and buy fewer inputs – which changes the net price or return to each input. Thus the job of the incidence analyst is to determine how those other prices change, and how those price changes affect different groups of individuals.” (Metcalf and Fullerton, 2002, p. 1) Tax incidence analysis has produced a number of generally accepted conclusions regarding the burden of different tax mechanisms. Remember, for example, that the payroll tax on paper is split equally between employer and employee: “So, who really pays the payroll tax? Is the payroll tax reflected in reduced profits for the employer or in reduced wages for the worker? ... there is generally universal agreement that the real burden of the tax falls almost entirely on the worker. Basically, an employer will only hire a worker if the cost to the employer of hiring that worker is no more than the value that worker can add. So, a worker is paid roughly what he or she adds to the value of production, minus the payroll tax; in effect, the whole tax is deducted from wages. ... to repeat, this is not a controversial view; it is the view of the vast majority of analysts...” (Krugman, 2001, p. 43) The most common assumption made regarding the allocation of corporate taxes is that the burden of these taxes falls almost exclusively on the owners of capital investments. Given the mobility of capital, the burden is not limited to owners of corporate capital but extends to owners of all capital. 16 This result is primarily a theoretical finding – in reality some portion of the corporate tax burden likely falls on workers (through lower wages) and consumers (through higher prices). Excise taxes, although directly paid by manufacturers, are generally attributed entirely to consumers according to their consumption patterns. 17 This result is based on an assumption of perfect competition in the affected industries. Real-world markets, however, are not perfectly competitive. The actual incidence of excise taxes will depend on the degree of competition in an industry. For example, imperfectly competitive industries with upward-sloping supply curves imply that prices increase by less than the tax and that a portion of excise taxes is borne by businesses. 18 16 See summary in Metcalf and Fullerton (2002). See CBO (2008). 18 See Fullerton and Metcalf (2002) for a summary of incidence assumptions and analyses for different types of taxes. 17 20 The burden of sales taxes is generally assumed to fall directly on consumers who buy the taxed goods and services. Again, this is a simplifying assumption – in reality some portion of sales taxes filters to corporate owners, other capital owners, and workers. Personal income taxes paid by households are directly attributed to those households paying the tax. Estate tax burdens fall on the heirs paying the tax. Finally, property tax burdens are generally assumed to fall on property owners although the burden can be passed on renters (some analysts attribute property taxes more broadly to owners of capital). So, for several types of tax mechanisms (personal income, sales, excise, and estate taxes), data on direct tax payments is analogous to tax incidence. However, for other taxes (payroll, corporate, and to a lesser extent property taxes) the direct data on tax payments will differ from the ultimate burden of the tax. Using Effective Tax Rate Data to Determine Tax Progressivity As mentioned before, a tax is progressive if the percentage of income a person pays for the tax increases as income increases. Thus, we can determine whether a tax is progressive or regressive by looking at a table showing the effective tax rates for a particular tax for people in different income categories. If effective tax rates increase (decrease) with increasing income, then the tax is progressive (regressive). Table 2 shows the percentage of income people in each adjusted gross income (AGI) category paid in federal income taxes in 2008, the most recent data available. We see that effective tax rates for the federal income tax tend to increase with increasing income (although not always). For taxpayers making less than $100,000 AGI per year, the Table 2. Distribution of Federal Income Taxes, 2008 AGI Category Percent of Returns 16.7 Average AGI $5,099 Average Income Taxes $177 Effective Income Tax Rate 3.5% 16.0 $14,927 $513 3.4% 13.0 $24,798 $1,421 5.7% 18.0 $39,126 $2,808 7.2% 13.5 $61,470 $5,246 8.5% 8.2 9.7 2.4 0.4 $86,421 $133,208 $285,735 $679,576 $8,037 $16,903 $55,984 $163,513 9.3% 12.7% 19.6% 24.1% 0.2 $3,349,101 $780,550 23.3% $1-$10,000 $10,000-$20,000 $20,000-$30,000 $30,000-$50,000 $50,000-$75,000 $75,000 - $100,000 $100,000-$200,000 $200,000-$500,000 $500,000$1,000,000 More than $1,000,000 21 effective federal income tax rate averages less than 10% of income. For those making more than $200,000 per year, the federal income tax averages more than 20% of income. The federal income tax is clearly progressive because those with higher incomes generally pay a larger share of their income for the tax. For a regressive tax, effective tax rates tend to decrease as income increases. If effective tax rates are constant at different income levels, then a tax is proportional. Looking at effective tax rates by income categories can normally determine whether a tax is progressive or regressive. However, there may be some cases where effective tax rates do not follow a consistent pattern across income levels. For example, suppose that effective taxes first increase but then decrease as we move up the income spectrum. Another limitation with data on effective tax rates is that this approach does not tell us the degree of progressivity or regressivity. We might not be able to determine whether one tax is more progressive than another or whether a particular tax becomes more or less progressive over time. Researchers have come up with several tax indices that measure the progressivity of a tax as a single number. These indices allow direct comparisons across different tax types and across time. The most common tax progressivity index is discussed in Box 2. Effective Tax Rates in the United States Data on the distribution of taxes in the U.S. are available from several sources. The government sources that publish data on tax distribution include the Internal Revenue Service (IRS), the Joint Committee on Taxation (JCT), the Congressional Budget Office (CBO), and the Office of Tax Analysis within the U.S. Treasury. The IRS data are the most detailed but focus on federal income and estate taxes. The IRS publishes data on corporate taxes but does not conduct tax incidence analysis. The JCT occasionally conducts tax incidence analyses but only on the federal income tax, payroll taxes, and federal excise taxes. The CBO adds the incidence of federal corporate taxes to their analyses but still omits the federal estate tax and all state and local taxes. The only source for tax incidence data for all taxes in the U.S. is Citizens for Tax Justice (CTJ), a non-profit organization. CTJ uses data from government sources but has developed its own models of tax incidence. Comparison of tax progressivity data from CTJ with data from the federal sources listed above indicates that their results are generally similar to the government’s results and not biased in either direction (Roach, 2003). 22 BOX 2. MEASURING TAX PROGRESSIVITY – THE SUITS INDEX The Suits Index, developed by Daniel Suits in the 1970s (Suits, 1977), calculates a single number that measures tax progressivity. The approach basically compares the cumulative share of income received by taxpayers, order from lowest to highest, to their cumulative share of taxes paid. For a progressive (regressive) tax, the share of taxes paid will tend to be less (more) than the share of income as we move up the income spectrum. Other tax progressivity indices have been developed but the Suits Index remains the most widely used approach (Anderson, et al., 2003). While the calculation details are not presented here, the Suits Index is a number ranging between –1 and +1. A negative Suits Index means that the tax is regressive while a positive index indicates a progressive tax (with a value of zero for a proportional tax). The Suits Index can be used to compare the degree of progressivity of different tax types as well as determine whether a tax becomes more or less progressive over time. The Suits Index has been used to estimate the progressivity of different tax types in the U.S. for 2007 (Roach, 2010). Table 2.1 shows that the U.S. tax system contains a mixture of progressive and regressive taxes. The federal estate tax is the most progressive tax while the federal corporate and income taxes are also progressive. On the other hand, federal excise taxes are the most regressive. Federal social insurance taxes and overall state and local taxes are also regressive. When all federal taxes are considered, the Suits Index of +0.18 indicates that federal taxation is progressive. The entire U.S. tax system is also progressive, but the recent Suits Indices of +0.05 and +0.06 are closer to a value of zero (a proportional tax) than just the federal tax system. Table 2.1. Suits Index Estimates of the U.S. Tax System, 2007, by Tax Type1 Tax Type Federal Income Federal Social Insurance Federal Excise Federal Corporate Federal Estate and Gift State and Local Total Federal All U.S. Taxes (2001 data) All U.S. Taxes (2004 data) All U.S. Taxes (2009 data) Suits Index +0.42 -0.20 -0.31 +0.51 +0.63 -0.12 +0.18 +0.09 +0.05 +0.06 __________________ 1 – The Suits Index for the federal estate and gift tax is based upon 2008 data. 23 Table 3 presents the tax distribution data from CTJ for 2009. We see that while the federal tax system is progressive, the state and local tax system is, on average, regressive. Overall, the tax system in the U.S. is progressive, although the rate of progressivity levels off at upper income levels and actually reverses at the highest income level in Table 3. Table 3. Effective Tax Rates, 2009 19 Effective Tax Rates Income Group Average Income Lowest 20% $12,400 Second 20% $25,000 Third 20% $40,000 Fourth 20% $66,000 Next 10% $100,000 Next 5% $141,000 Next 4% $245,000 Top 1% $1,328,000 ALL $68,900 Federal Taxes 3.6% 8.7% 13.9% 17.2% 19.0% 20.4% 21.3% 22.3% 18.0% State & Local Taxes 12.4% 11.8% 11.3% 11.3% 11.1% 10.8% 10.2% 8.4% 10.6% All Taxes 16.9% 20.5% 25.3% 28.5% 30.2% 31.2% 31.6% 30.8% 28.6% Tax Progressivity over Time Consistent data are generally not available to determine how the entire tax burden in the U.S. has shifted over time. Most analyses are limited to one, or a few, tax types. Further, interest groups can interpret the available data to support their particular agendas. For an illustration about how the same tax data can be used to support different claims, see Box 3. Analysis of tax progressivity over time indicates that the federal tax system is about as progressive now as it was in the late 1970s (Roach, 2010). The progressivity of the federal tax system declined during the early 1980s, rose in 1987 (the year following the passage of the Tax Reform Act of 1986), either remained stable or rose slightly up to the mid-200s, and decreased slightly since the mid-200s. Complete data on the distribution of state and local taxes are available from Citizens for Tax Justice for 1995, 2002, 2007, and 2009, with Suits Indices of -0.11, -0.07, -0.12, and -0.07 respectively. Thus the available data suggest no obvious overall trend in the regressivity of state and local taxes. The unavailability of consistent data on the distribution of state and local taxes makes determination of the trends in the overall U.S. 19 Data from CTJ, 2010. 24 tax system difficult to determine. As Table 2.1 indicated, total taxes declined in progressivity from 2001 to 2004, and then stayed about the same from 2004 to 2009. BOX 3. INTERPRETING TAX PROGRESSIVITY DATA Has the federal income tax burden on the very wealthy been increasing or decreasing in recent decades? Data published by the CBO reveals that the percent of federal income taxes paid by the highest-income taxpayers has increased steady over the past few decades. In 1979, the top 1% of taxpayers paid about 18.3% of all federal income taxes. In 2007, the top 1% of taxpayers paid over 39.5%. Clearly, these data suggest that the federal income tax has become much more progressive since 1979. However, these statistics represent an incomplete analysis. Specifically, it fails to consider how the proportion of income accruing to the top 1% has changed over the same time period. The increasing tax share paid by high-income taxpayers may be a function of an increase in income, rather than a change in the tax system. In other words, if the share of all income received by the top 1% increased, we would naturally expect that their share of taxes paid would also increase without any changes in the underlying progressivity of the tax system. Income statistics indicate that the share of income going to the top 1% of taxpayers has also increased significantly since 1979. The top 1% of taxpayers received less than 9.2% of income in 1979 but more than 19.4% in 2007. Based on this fact alone, we would expect the top 1% to be paying a greater share of all federal income taxes. So, has the federal income tax burden on the top 1% increased or decreased since 1979? We can combine the tax and income data for a more complete analysis. The share of income going to the top 1% increased by a factor of 2.1 between 1979 and 2007. Meanwhile, their share of taxes paid has increased by a factor of 2.2. This suggests that the share of taxes paid by the top 1% has risen by about as much as much as their share of income – indicating a relatively stable degree of tax progressivity in the federal income tax – a dramatically different conclusion had we only considered data on tax shares! 25 References Brownlee, W. Elliot. 1996. Federal Taxation in America. University of Cambridge Press: Cambridge. Chaptman, Dennis. 2003 “States' Budget Troubles Worsening, Report Finds,” Milwaukee Journal Sentinel, Feb. 5, 2003. Citizens for Tax Justice, Institute on Taxation & Economic Policy. 2003a. “Who Pays? A Distributional Analysis of the Tax Systems in All 50 States, 2nd Edition,” January 2003, http://www.itepnet.org/wp2000/text.pdf. Citizens for Tax Justice. 2010. “All Americans Pay Taxes,” April 15, 2010. http://www.ctj.org/pdf/taxday2010.pdf. Citizens for Tax Justice. 2003b. “Final Tax Plan Tilts Even More Towards Richest,” June 5, 2003 press release, http://www.ctj.org/pdf/sen0522.pdf. Citizens for Tax Justice. 2002. “White House Reveals Nation’s Biggest Problems: The Very Rich Don’t Have Enough Money & Workers Don’t Pay Enough in Taxes,” December 16, 2002 press release, http://www.ctj.org/pdf/flat1202.pdf. Citizens for Tax Justice. 2001. “Final Version of Bush Tax Plan Keeps High-End Tax Cuts, Adds to Long-Term Cost,” May 26, 2001 press release, http://www.ctj.org/html/gwbfinal.htm. Congressional Budget Office, “Effective Federal Tax Rates, 2005,” December 2008. Fullerton, Don, and Gilbert E. Metcalf, 2002. “Tax Incidence,” National Bureau of Economic Research Working Paper 8829. IRS (Internal Revenue Service). Various Years. Statistics of Income, Individual Income Tax Returns. Washington, D.C. IRS (Internal Revenue Service). 2002. “Personal Exemptions and Individual Income Tax Rates, 1913-2002.” Statistics of Income Bulletin Data Release, June 2002. Johnson, Charles M. 2002. “Finding their Balance?” Missoulian, December 8, 2002.Joint Committee on Taxation. 2001. “Updated Distribution of Certain Federal Tax Liabilities by Income Class for Calendar Year 2001,” JCX-65-01.Krugman, Paul. 2002. “For Richer,” The New York Times, October 20, 2002, section 6, page 62. Krugman, Paul. 2001. Fuzzy Math: The Essential Guide to the Bush Tax Cut Plan, W.W. Norton & Company: New York. 26 Martin, Cathie J. 1991. Shifting the Burden: The Struggle over Growth and Corporate Taxation. The University of Chicago Press: Chicago. Metcalf, Gilbert E. and Don Fullerton. 2002. “The Distribution of Tax Burdens: An Introduction,” National Bureau of Economic Research Working Paper 8978. OECD (Organisation for Economic Co-operation and Development). 2010. “More Information on Environmentally Related Taxes, Fees and Charges,” http://www2.oecd.org/ecoinst/queries/index.htm. OMB (Office of Management and Budget). 2003. “Historical Tables, Budget of the United States Government, Fiscal Year 2004.” Washington, D.C. Peterson, Wallace C. 1999. The Social Security Primer: What Every Citizen Should Know. M.E. Sharpe: Armonk, NY. Petska, Tom, and Mike Strudler. 1999. “The Distribution of Individual Income and Taxes: A New Look at an Old Issue.” Paper presented at the 1999 American Economics Association conference, January 3-5, 1999, New York, http://www.irs.gov/taxstats/article/0,,id=112309,00.html. Roach, Brian. 2010. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 10-07, December 2010. Roach, Brian. 2003. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 03-10, October 2003. Skidmore, Max J. 1999. Social Security and Its Enemies. Westview Press: Boulder, CO. Tax Policy Center. 2010. “Wealth Transfer Taxes: Who Pays the Estate Tax?” The Tax Policy Briefing Book, http://www.taxpolicycenter.org/briefing-book/keyelements/estate/who.cfm. Tax Policy Center. 2008. “Estate Tax Returns and Liability Under Current Law and Various Reform Proposals, 2008-2018,” Table T08-0264, October 20, 2008. Tempalski, Jerry. 1998. “Revenue Effects of Major Tax Bills.” Office of Tax Analysis Working Paper 81, December 1998. U.S. Census Bureau. 2003. “Historical Income Tables - Income Equality, Table IE-1,” http://www.census.gov/hhes/income/histinc/ie1.html. U.S. Census Bureau. 2010. The 2010 Statistical Abstract of the United States. Washington, D.C. 27 U.S. Census Bureau. Various Years. Statistical Abstract of the United States. Washington, D.C. U.S. Census Bureau. 1960. Historical Statistics of the United States, Colonial Times to 1957. Washington, D.C. 28 MODULE SUMMARY • The overall tax system in the United States is progressive, meaning that effective tax rates tend to increase as income increases. Progressive taxation is based on the view that higher-income taxpayers can pay higher tax rates without having to forego life’s basic necessities. Progressive taxation can also redress economic inequalities and collect a given level of revenue while maintaining the maximum level of economic growth. • The federal income tax is the most complicated and debated tax in the U.S. tax system. The federal income tax is progressive, with increasing marginal tax rates. Federal income taxes are calculated based on taxable income, which is less than total income because various exemptions and deductions are allowed. • The federal tax system in the U.S. also includes social insurance, corporate, excise, estate, and gifts taxes. Social insurance and excise taxes are regressive while corporate, estate, and gift taxes are progressive. The U.S. tax system also includes state and local taxes, primarily sales, income, and property taxes. • Nearly 70% of the taxes levied in the U.S. are collected at the federal level. The largest federal tax is the income tax, closely followed by social insurance taxes. The most significant non-federal tax is property taxes, followed by sales and income taxes. • Up until the early 1900s, the U.S. tax system primarily relied on excise taxes and tariffs for public revenues. The 16th Amendment, ratified in 1913, created the legal basis for federal income taxation, which up to that point had been prohibited under the Constitution. • Both World Wars led to significant changes in the structure and overall magnitude of taxes in the U.S. By the end of World War II, U.S. taxes were broad-based but progressive and dominated by federal-level taxation. • Tax cuts passed during the Reagan Administration in the 1980s were based on the theory that lower tax rates would spur economic growth, leading to a net increase in tax revenues. This theory was not supported by the evidence, eventually leading to tax increases in the early 1990s. The Bush tax cuts passed in 2001 and 2003 have made federal taxes less progressive. • Tax revenues in the U.S. increased dramatically during the 20th century, even after adjusting for inflation. When measured as a percentage of GDP, tax revenues grew significantly during World War II, grew at a slower pace afterwards, and leveled off recently at around 30% of GDP. 29 • Measuring the distribution of taxes requires tax incidence analysis, which determines the ultimate burden of a tax on taxpayers. Tax incidence analysis generally concludes that social insurance taxes fall on workers, corporate taxes fall on the owners of capital, excise taxes fall on consumers, and property taxes are passed on to renters. • Effective tax rates measured by income level can be used to determine whether a particular tax is progressive or regressive. While the U.S. tax system contains both progressive and regressive taxes, the overall system is progressive. Recent data suggest that federal taxes are becoming less progressive while state and local taxes are becoming more regressive. 30 DISCUSSION QUESTIONS 1. Comment on the following statement: “The fairest type of tax system is one in which everyone pays the same rate of taxation, regardless of income.” Do you agree or disagree with the statement? Why? 2. Suppose you could set the overall effective tax rates across different levels of income. What do you think should be the appropriate effective tax rates for a household of four (two adults and two children) with an income of $25,000? An income of $60,000? An income of $100,000? An income of $500,000? Is the system you devise more or less progressive than the tax system currently in place in the U.S.? How does your system compare with others in your class? 3. The U.S. tax system is currently comprised of many different types of taxes (income, social insurance, corporate, sales, property, etc.). What reasons could be given to support the use of many different tax types in a nation? Do you think that a nation’s tax system should be comprised of many different types of taxes or just one type of tax? If you had to choose just one type of tax to levy in a nation, what type of tax would you choose? Why? 4. Comment on the following statement: “As long as a tax cut reduces taxes for everyone, then everyone will be better off as a result of the tax cut.” Do you agree with this statement? Why or why not? 5. Using the Internet or other sources, look up information about basic structure of the tax system in place in a country other than the United States. What differences are evident in that country’s tax system? Do you think that country has a more or less progressive tax system? Which nation’s tax system is preferable to you? Why? 6. Locate a recent news story about a proposal for a change to the tax system, either at the federal or state level. Summarize the proposed change. Would the change increase or decrease tax progressivity? Who would benefit most from the proposal? Who would be hurt the most from the proposal? Do you support the proposal? Why or why not? 31 ADDITIONAL RESOURCES • All the federal government agencies that work on tax issues maintain web sites that provide tax data and reports. The IRS’s Statistics of Income Bulletins, published four times a year, can be found dating back to 1998 at http://www.irs.gov/taxstats/article/0,,id=117514,00.html. The SOI Bulletins provide data analysis of primarily individual and corporate taxes. Publications produced by the Joint Committee on Taxation can be found at http://www.jct.gov/publications.html. Publications by the Congressional Budget Office related to tax issues, going as far back as the 1970s, are available at http://www.cbo.gov/publications/bysubject.cfm?cat=33. Finally, tax analysis by the U.S. Treasury Department, only dating back to 2001, can be found at http://www.treasury.gov/resource-center/tax-policy/Pages/default.aspx. • A large amount of tax-related data is published annually in the Statistical Abstract of the United States. Each year’s edition includes a chapter on state and local government finances and another chapter on federal government finances. The Census Bureau has recently added select historical editions of the Statistical Abstract dating as far back as 1878, although online availability is more complete for the first half of the 20th century than the latter half of the century (see http://www.census.gov/compendia/statab). • Citizens for Tax Justice publishes many other tax analyses besides those referenced in this module. Their web site is www.ctj.org. Two other non-profit organizations that conduct tax analysis are the Tax Policy Center, a joint venture of the Urban Institute and Brookings Institution, and the Center for Budget and Policy Priorities. The Tax Policy Center (www.taxpolicycenter.org) publishes several reports each month on a wide range of tax issues, including distributional impacts and public budget implications. The CBPP (www.cbpp.org) research focuses on “fiscal policy and public programs that affect low- and moderate-income families and individuals.” Similar to the Tax Policy Center, the CBPP conducts distributional analyses of current tax proposals. • For an opposing view on tax issues, the Tax Foundation (www.taxfoundation.org) publishes tax analyses that generally support lower overall taxes and conclude that the distributional impacts of recent tax cuts are fair. A similar organization, with a more activist agenda, is Americans for Tax Reform (www.atr.org). 32 KEY TERMS AND CONCEPTS Ability-to-pay principle: the idea that higher-income households and individuals should pay higher tax rates than lower-income taxpayers because they are more able to bear the tax without foregoing life’s basic necessities. Adjusted gross income (AGI): the total income of a household or individual minus certain out-of-pocket expenses such as retirement account contributions, student loan interest, tuition, and other allowable subtractions. AGI is calculated on one’s federal tax return. Effective tax rate: one’s total taxes paid divided by some measure of income, such as total income, adjusted gross income, or taxable income. Environmental taxes: taxes levied on a good or service based on the environmental impact of its production or consumption. Estate taxes: taxes on the transfer of large estates to beneficiaries. Excise taxes: taxes on the production, sale, or use of a particular commodity. Exemptions: an amount excluded from taxation based on the number of tax filers and dependents. Gift taxes: taxes levied on large gifts; gift taxes are designed to prevent taxpayers from avoiding estate taxes by giving away their assets while alive. Itemized deductions: certain expenses excluded from federal taxation, including mortgage interest, state taxes, gifts to charity, real estate taxes, and major medical expenses. A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Marginal propensity to consume: the proportion of a marginal income increase that is spent on consumption goods and services, as opposed to invested or saved. Marginal tax rates: a tax system where a single taxpayer can pay different tax rates on successive portions of income. National consumption tax: a federal-level tax paid on the dollar amount a household or individual spends each year on goods and services, calculated using either a single tax rate or marginal tax rates. National sales tax: a federal-level tax paid on the purchase of certain goods and services, calculated as a percentage of the selling price. 33 Perfect competition: an idealized market structure characterized by many informed small firms with no market power selling undifferentiated products and with complete freedom to enter or exit the market. Progressive tax: a tax in which the percentage of income one pays for the tax increases as one’s income increases. Proportional tax: a tax in which the percentage of income one pays for the tax is constant regardless of income level. Regressive tax: a tax in which the percentage of income one pays for the tax decreases as one’s income increases. Social insurance taxes: taxes paid to support social insurance programs such as Social Security, Medicare, and Medicaid. Standard deduction: a fixed amount of income excluded from federal taxation based on filing status (single, married, etc.). A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Suits index: an index developed by Daniel Suits in the 1970s to measure the overall progressivity or regressivity of a tax. Tariffs: taxes levied on imported goods and services. Tax incidence analysis: estimating the ultimate financial burden of various taxes on different categories of households by tracing a tax’s impact on market prices and the economic behavior of consumers and businesses. Taxable income: the amount of income used as the basis for determine one’s income taxes. For federal income taxes, taxable income is equal to adjusted gross income (AGI) minus allowable deductions and exemptions. Total income: the total income a household or individual receives from all sources Value-added tax: a tax levied at each stage in the production process of a good or service. Wealth taxes: taxes levied on the value of one’s assets such as real estate, investments, cash, and other personal property. 34
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Taxes in the United States: History, Fairness, and Current Political Issues by Brian Roach A GDAE Teaching Module on Social and Environmental Issues in Economics Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae Copyright © 2010 Global Development And Environment Institute, Tufts University. Copyright release is hereby granted for instructors to copy this module for instructional purposes. Students may also download the module directly from http://ase.tufts.edu/gdae. Comments and feedback from course use are welcomed: Tufts University Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae E-mail: [email protected] I. INTRODUCTION “The hardest thing in the world to understand is income tax!” – Albert Einstein Taxes are complicated. The U.S. federal tax code contains over three million words – about 6,000 pages. A casual browsing of the tax code’s table of contents offers a glimpse into the vast complexity of federal taxation. Entire sections of the tax code apply specifically to the taxation of vaccines (Sec. 4131-4132), shipowners' mutual protection and indemnity associations (Sec. 526), specially sweetened natural wines (Sec. 5385), and life insurance companies (Sec. 801-818). Annual changes to the tax code imply that taxes will continue to become more complex even as politicians tout tax simplification. Taxes levied by other jurisdictions, such as states and cities, add further complexity to taxation in the U.S. Americans spend billions of hours each year working on their taxes, not to mention the costs of accountants and tax preparers. Fortunately, one needn’t comprehend the imposing complexity of the tax code to understand the crucial role of taxes in American society. Taxation is an important, but commonly neglected, topic for students of economics, political science, and other disciplines. Tax policy has important economic consequences, both for the national economy and for particular groups within the economy. Tax policies are often designed with the intention of stimulating economic growth – although economists differ drastically about which policies are most effective at fostering growth. Taxes can create incentives promoting desirable behavior and disincentives for unwanted behavior. Taxation provides a means to redistribute economic resources towards those with low incomes or special needs. Taxes provide the revenue needed for critical public services such as social security, health care, national defense, and education. Taxation is as much of a political issue as an economic issue. Political leaders have used tax policy to promote their agendas by initiating various tax reforms: decreasing (or increasing) tax rates, changing the definition of taxable income, creating new taxes on specific products, etc. Of course, no one particularly wants to pay taxes. Specific groups, such as small-business owners, farmers, or retired individuals, exert significant political effort to reduce their share of the tax burden. The voluminous tax code is packed with rules that benefit a certain group of taxpayers while inevitably shifting more of the burden to others. Tax policy clearly reflects the expression of power in the U.S. – those without power or favor are left paying more in taxes while others reap the benefits of lower taxes because of their political influence. Broad attempts to reform the tax system have produced dramatic and sudden shifts in tax policy, generally motivated by political factors rather than sound economic theory. For example, the top marginal federal tax bracket on individual income in the U.S. dropped precipitously from 70% to 28% during the 1980s. Tax policy has clearly been used to promote political, as well as economic, agendas. This module is intended to provide a basic understanding of the economic, political, and social context of the entire U.S. tax system. When most people think about taxes, they 1 tend to think only of the federal income tax. However, looking solely at the federal income tax would miss several important issues. Perhaps most importantly, the federal income tax is not the largest tax bill to most Americans. We’ll see that the largest tax for most Americans is federal social insurance taxation. Also, the federal income tax is one of the most progressive taxes in the U.S. system. When all taxes are considered, the U.S. tax system is much less progressive. You may be surprised to find out how many taxes in the U.S. are actually regressive – hitting low-income households at a disproportionately high rate. This module is divided into three major sections. First, some basic terms will be defined and discussed, including tax progressivity and the differences between several types of taxes. Second, a brief overview of tax history in the United States will be presented. Third, data on tax trends will be used to illustrate the changing nature of taxation with a focus on the overall progressivity of the entire tax system. II. THE STRUCTURE OF TAXATION IN THE UNITED STATES Tax Progressivity The overall system of taxation in the United States is progressive. By a progressive tax system, we mean that the percentage of income an individual (or household) pays in taxes tends to increase with increasing income. Not only do those with higher incomes pay more in total taxes, they pay a higher rate of taxes. This is the essence of a progressive tax system. For example, a person making $100,000 in a year might pay 25% of their income in taxes ($25,000 in taxes), while someone with an income of $30,000 might only pay a 10% tax rate ($3,000 in taxes). A tax system may also be regressive or proportional. A regressive tax system is one where the proportion of income paid in taxes tends to decrease as one’s income increases. A proportional tax system simply means that everyone pays the same tax rate regardless of income. A particular tax system may display elements of more than one approach. Consider a hypothetical tax system where one pays a proportional, or flat 1 , rate on income below a certain dollar amount and then progressively increasing rates above that dollar amount. Also, within an overall tax system, some particular taxes might be progressive while other taxes are regressive. We’ll see later on that this the case in the United States. The Reasons for Progressive Taxation The overall tax system of the United States, and in most other countries, is progressive for a number of reasons. A progressive tax embodies the concept that those with high incomes should pay more of their income in taxes because of their greater ability to pay 1 This is not exactly the same concept embodied in current proposals for a “flat tax” in the U.S. These proposals would set just one tax rate but would exclude a given amount of income from taxation. Thus, the flat tax proposals would retain a small degree of progressivity. 2 without critical sacrifices. By paying a tax, any household must forego an equivalent amount of spending on goods, services, or investments. For a high-income household, these foregone opportunities might include a second home, an expensive vehicle, or a purchase of corporate stock. A low-income household, by comparison, might have to forego basic medical care, post-secondary education, or vehicle safety repairs. As income increases, the opportunity costs of paying taxes tend to be associated more with luxuries rather than basic necessities. The ability-to-pay principle recognizes that a flat (or regressive) tax rate would impose a larger burden, in terms of foregone necessities, on low-income households as compared to high-income households. A progressive tax system is also a mechanism to addresses economic inequalities in a society. To evaluate a tax system’s impact on inequality, one must consider both the distribution of taxes paid and the distribution of the benefits derived from tax revenue. If the benefits of programs funded by taxation primarily benefit low-income households while high-income households pay the majority of taxes, then the tax system effectively operates as a transfer mechanism. Increasing the progressivity of the tax system or altering the distribution of benefits allows greater redistribution of economic resources. We’ll mainly focus on tax payments in this module but you should also be aware that the benefits of public expenditures are not evenly distributed throughout society. 2 There is also an economic argument for a progressive tax system – it may yield a given level of public revenue with the least economic impact. To see why, consider how households with different levels of income would respond to a $100 tax cut. A lowincome household would tend to quickly spend the entire amount on needed goods and services – injecting $100 of increased demand into the economy. By comparison, a highincome household might only spend a fraction on goods and services, choosing to save or invest a portion of the money. The money that a high-income household saves or invests does not add to the overall level of effective demand in an economy. 3 In economic terms, we say that the marginal propensity to consume tends to decrease as income increases. So, by collecting proportionally more taxes from high-income households we tend to maintain a higher level of effective demand and more economic activity. Of course, one can posit that a tax system can become too progressive. Extremely high tax rates at high-income levels might create a significant disincentive that reduces the productive capacity of society. Very high taxes might limit the risks taken by entrepreneurs, stifling innovations and technological advances. The desire to “soak the rich” through an extremely progressive tax system might be viewed as unfair, and not just by the rich. In fact, this was a concern of the Constitutional framers – that a democratic majority would eventually impose unduly burdensome taxes on the wealthy minority. We’ll see that their concerns have proved groundless. Many critics of the current tax 2 The distribution of the benefits derived from public expenditures is, of course, more difficult to determine that the distribution of tax payments. The distribution of public assistance programs can be easily measured. However, the distribution of the benefits of scientific research support, business subsidies, public works, national defense, and other expenditures is a difficult research task. 3 Money saved or invested may, however, provide the financial capital necessary to increase the productive capacity of the economy. “Supply-side” economists stress the importance of investment by the wealthy as the key to economic growth. 3 system point to the contrary position – that the powerful minority have used their might to shift the tax burden away from themselves onto an immobilized and misinformed majority. Even if one could devise a tax system that is economically optimal (i.e., producing the highest overall level of economic growth), the topic of taxation encompasses ideals about equity and fairness. A society may be willing to sacrifice some degree of economic growth in exchange for a more equitable distribution of economic resources. This is not to say that economic growth must always be sacrificed with redistribution. In fact, analysis of the U.S. historical data finds that high levels of economic growth tend to be associated with periods of relatively equitable distribution of economic resources (Krugman, 2002). We now turn to differentiating between the different types of taxes levied in the U.S. We’ll first discuss several forms of federal taxation, roughly in order of the revenue they generate, and then consider taxation at the state and local levels. A final section will consider taxes that are generally not used in the U.S. but are important in other nations. Federal Income Taxes The federal income tax is the most visible, complicated, and debated tax in the U.S. The federal income tax was established with the ratification of the 16th Amendment to the U.S. Constitution in 1913. It is levied on wages and salaries as well as income from many other sources including interest, dividends, capital gains, self-employment income, alimony, and prizes. To understand the basic workings of federal income taxes, you need to comprehend only two major issues. First, all income is not taxable – there are important differences between “total income,” “adjusted gross income,” and “taxable income.” Second, you need to know the distinction between a person’s “effective tax rate” and “marginal tax rate.” Total income is simply the sum of income an individual or couple 4 receives from all sources. For most people, the largest portion of total income comes from wages or salaries. Many people also receive investment income from the three standard sources: interest, capital gains, and dividends. Self-employment income is also included in total income, along with other types of income such as alimony, farm income, and gambling winnings. The amount of federal taxes a person owes is not calculated based on total income. Instead, once total income is calculated, tax filers are allowed to subtract some expenses as non-taxable. To obtain adjusted gross income (AGI), certain out-of-pocket expenses made by a tax filer are subtracted from total income. These expenses include individual retirement account contributions, allowable moving expenses, student loan interest, tuition, and a few other expenses. AGI is important because much of the tax data presented by the IRS are sorted by AGI. 4 Married couples have the option of filing their federal taxes either jointly or separately. Children aged 14 or over with sufficient income ($7,700 in 2002) have to file their own federal income tax returns. 4 However, taxes are not calculated based on AGI either. Taxable income is basically AGI less deductions and exemptions. Deductions are either standard or itemized. The standard deduction is a fixed amount excluded from taxation – for the 2009 tax year the standard deduction was $5,700 for single individuals and $11,400 for married couples. Tax filers have the option of itemizing their deductions. To itemize, a tax filer adds up certain expenses made during the year including state taxes, real estate taxes, mortgage interest, gifts to charity, and major medical expenses. 5 If the itemized deductions exceed the standard deduction, then the itemized total is deducted instead. Exemptions are calculated based on the number of tax filers and dependents. A single tax filer with no dependent children can claim one exemption. A married couple with no children can claim two exemptions. Each dependent child counts as one more exemption. Additional exemptions are given for being age 65 or over or blind. In 2009, each exemption excluded a further $3,650 from taxation. 6 Taxable income is obtained by subtracting the deduction and exemption amounts from AGI. This is the amount a taxpayer actually pays taxes on. However, the amount of tax owed is not simply a multiple of taxable income and a single tax rate. The federal income tax system in the U.S. uses increasing marginal tax rates. This means that different tax rates apply on different portions of a person’s income. The concept is best illustrated with an example using the 2009 tax rates. For a single filer, the first $8,350 of taxable income (not total income or AGI) is taxed at a rate of 10%. Taxable income above $8,350 but less than $33,950 is taxed at a rate of 15%. Taxable income above $33,950 but less than $82,250 is taxed at a rate of 25%. Income above $82,250 is taxed at higher marginal rates – 28%, 33%, and 35%. Consider how we would calculate the taxes due for a single tax filer (let’s call her Susan) with no children and a total income of $35,000. Assume Susan contributed $3,000 to an individual retirement account and that this is her only allowable adjustment expense. Thus, her AGI is $32,000. She claims one exemption (herself) in the amount of $3,650 and the standard deduction of $5,700. Thus, Susan’s taxable income is $22,650. On the first $8,350 of taxable income she owes 10% in taxes, or $835. The tax rate on the rest of her income is 15% for a tax of $2,145, (($22,650 - $8,350) × 0.15). So, her total federal income tax bill is $2,980, ($835 + $2,145). Note that Susan’s taxable income is $12,350 less than her total income. While Susan paid a maximum tax rate of 15%, we can see that her effective tax rate is much lower. An effective tax rate can be calculated based on total income, AGI, or taxable income. Suppose we wish to calculate Susan’s effective tax rate based on her total income of $35,000. Given that her federal income tax is $2,980, her effective tax rate is only 8.5%, (($2,980/$35,000) × 100). If we based her effective tax rate on her AGI, it would be 9.3%, (($2,980/$32,000) × 100). 5 Note that some expenses, such as moving costs, are subtracted from total income to obtain AGI while other expenses, such as mortgage interest, are classified as deductions from AGI to obtain taxable income. 6 Those with high incomes (more than $125,100 for an individual) either have their exemption allowance either reduced or eliminated. 5 Social Insurance Taxes Taxes for federal social insurance programs, including Social Security, Medicaid, and Medicare, are taxed separately from income. Social insurance taxes are levied on salaries and wages, as well as income from self-employment. For those employed by others, these taxes are generally deducted directly from their paycheck. These deductions commonly appear as “FICA” taxes – a reference to the Federal Insurance Contributions Act. Self-employed individuals must pay their social insurance taxes when they file their federal income tax returns. Social insurance taxes are actually two separate taxes. The first is a tax of 12.4% of wages, which is primarily used to fund Social Security. Half of this tax is deducted from an employee’s paycheck while the employer is responsible for matching this contribution. The other is a tax of 2.9% for the Medicare program. Again, the employee and employer each pay half. Thus, social insurance taxes normally amount to a 7.65% deduction from an employee’s wage (6.2% + 1.45%). Self-employed individuals are responsible for paying the entire share, 15.3%, themselves. There is a very important difference between these two taxes. The Social Security tax is due only on the first $106,800 (in 2009) of income. On income above $106,800, no additional Social Security tax is paid. In other words, the maximum Social Security tax in 2009 that would be deducted from total wages is $6,622 ($106,800 × 0.062). The Medicare tax, however, is paid on all wages. Thus, the Medicare tax is truly a flat tax while the Social Security tax is a flat tax on the first $106,800 of income but then becomes a regressive tax when we consider income above this limit. Consider the impact of social insurance taxes on two individuals, one making a typical salary of $45,000 and another making $300,000. The typical worker would pay 7.65% on all income, or $3,443, in federal social insurance taxes. The high-income worker would pay the maximum Social Security contribution of $6,622 plus $4,350 for Medicare (1.45% of $300,000) for a total bill of $10,972. This works out to a 3.7% overall tax rate, or less than half the tax rate paid by the typical worker. As the high-income individual pays a lower rate of taxation, we see that social insurance taxes are regressive. Federal Corporate Taxes Corporations must file federal tax forms that are in many ways similar to the forms individuals complete. Corporate taxable income is defined as total revenues minus the cost of goods sold, wages and salaries, depreciation, repairs, interest paid, and other deductions. Thus corporations, like individuals, can take advantage of many deductions to reduce their taxable income. In fact, a corporation may have so many deductions that it actually ends up paying no tax at all or even receives a rebate check from the federal government. We’ll discuss this issue further later in the module. Corporate tax rates, like personal income tax rates, are progressive and calculated on a marginal basis. In 2009, the lowest corporate tax rate, applied to profits lower than 6 $50,000 was 15%. The highest marginal corporate tax rate, applied to profits between $100,000 and $335,000 was 39%. 7 As with individuals, the effective tax rate corporations pay is lower than their marginal tax rate. Federal Excise Taxes An excise tax is a tax on the production, sale, or use of a particular commodity. The federal government collects excise taxes from manufacturers and retailers for the production or sale of a surprising number of products including tires, telephone services, air travel, transportation fuels, alcohol, tobacco, and firearms. Unlike a sales tax, which is evident as an addition to the selling price of a product, excise taxes are normally incorporated into the price of a product. In most cases, consumers are not directly aware of the federal excise taxes they pay. However, every time you buy gas, make a phone call, fly in a commercial plane, or buy tobacco products, you are paying a federal excise tax. For example, the federal excise tax on gasoline as of 2009 was about 18 cents per gallon. Federal excise taxes are another example of a regressive tax. Lower-income households tend to spend a greater portion of their income on goods that are subject to federal excise taxes. This is particularly true for gasoline, tobacco, and alcohol products. Federal Estate and Gift Taxes The vast majority of Americans will never be affected by the federal estate or gift taxes. These taxes apply only to the wealthiest Americans. The estate tax is applied to transfers of large estates to beneficiaries. Similar to the federal income tax, there is an exemption amount that is not taxed. Only estates valued above the exemption amount are subject to the estate tax, and the tax only applies to the value of the estate above the exemption. For example, if the tax rate were 45% of the exemption amount was $2 million, then the tax on an estate valued at $3.5 million would be $675,000, ((3,500,000-2,000,000)*0.45). As of Fall 2010, the future of the estate tax is in limbo. Under the Economic Growth and Tax Relief Act of 2001, estate taxes rates were gradually reduced, and exemption rates gradually increased, over the period 2001-2009. In 2001, the exemption amount was $675,000 million and the tax rate was 55%. For the 2009 tax year, the exemption amount was $3.5 million and the tax rate was 45%. But for 2010, there is no estate tax at all! Then, in 2011, the tax is scheduled to be reinstated with an exemption of $1 million and a tax rate of 55%. The ongoing debate over the estate tax will be covered in more detail later in this module. The transfer of large gifts is also subject to federal taxation. The estate tax and gift tax are complementary because the gift tax essentially prevents people from giving away their estate to beneficiaries tax-free while they are still alive. In 2009, gifts under 7 For the highest profit bracket – profits above $18,333,333 – the marginal rate was 35%. 7 $13,000 were excluded from the tax. Similar to the federal income tax, the gift tax rates are marginal and progressive, with a maximum tax rate of 45%. The estate and gift taxes are the most progressive element of federal taxation. The estate tax is paid exclusively by those with considerable assets. Even further, the majority of all estate taxes are paid by a very small number of wealthy taxpayers. According to the Tax Policy Center, in 2009 the richest 0.1% of those subject to the estate tax pay 42% of the total estate tax revenue. (Tax Policy Center, 2010). State and Local Taxes Like the federal government, state governments also rely on tax revenues to fund public expenditures and transfer programs. Like the federal government, state governments rely on several different tax mechanisms including income taxes, excise taxes, and corporate taxes. Thus, much of the above discussion applies to the tax structures in place in most states. However, there are some important differences that deserve mention. First, nearly all states (45 as of 2010) have instituted some type of general sales tax. State sales tax rates range from 2.9% (Colorado) to 8.25% (California 8 ). A few states reduce the tax rate on certain goods considered to be necessities, such as food and prescription drugs. For example, the general sales tax in Illinois is 6.25% but most food and drug sales are taxed at only 1%. Other states with sales taxes exempt some necessities from taxation entirely. In most states, localities can charge a separate sales tax. While local sales taxes are generally lower than state sales taxes, there are exceptions. In New York the state sales tax is 4% but local sales taxes are often higher than 4%. Unlike income taxes, sales taxes tend to be quite regressive. The reason is that lowincome households tend to spend a larger share of their income on taxable items than high-income households. Consider gasoline – an item that tends to be a smaller share of total expenditures as income rises. An increase in the state taxes on gasoline impacts low-income households more than high-income households. Some states, such as Idaho and Kansas, offer low-income households a tax credit to compensate for the regressive nature of state sales taxes. Forty-one states levy an income tax. 9 Most of these states have several progressive tax brackets (up to 12 rates) similar to the federal income tax. However, state income taxes tend to be much less progressive than the federal income tax. Six states have only one income tax rate, meaning that their income tax approaches a flat tax. Several more states approach a flat tax because the top rate applies at a low income or the rates are relatively constant. For example, Maine’s two tax rates are 6.50% and 6.85%. 8 Local sales taxes are also levied in some municipalities in California, which can raise the total sales tax to as high as 10.75%. 9 Two other states, Tennessee and New Hampshire, levy no state income tax but do tax dividends and interest. 8 Another important distinction between the federal system of taxation and the taxes levied at state and local levels is use of property taxes. In fact, property taxes tend to be the largest revenue source for state and local governments. The primary property tax levied in the U.S. is a tax on real estate, including land, private residences, and commercial properties. Generally, the tax is an annual assessment calculated as a proportion of the value of the property, although the formulas used by localities differ significantly. Property taxes are commonly collected at a local level, but a share of property taxes is allocated for state purposes. Property taxes tend to be regressive, although less regressive than excise and sales taxes. The reason is that high-income households tend to have a lower proportion of their assets subjected to property taxes. While renters do not directly pay property taxes, most economists conclude that the costs of property taxes are largely passed on to renters in the form of higher rents. Composition of Tax Collections in the U.S. Table 1 presents government tax receipts, by tax source, for 2008 (the most recent year for which complete data were available). The table shows that federal taxes dominate the nation’s tax system with nearly 65% of all receipts. The largest federal tax is the income tax, followed closely by social insurance taxes. State and local tax systems are primarily dependent on sales, income, and property taxation. The data in Table 1 cover the major taxes utilized in the United States. To gain a broader perspective on taxation, see Box 1 for a summary of tax mechanisms that are major revenue sources for some countries but are currently non-existent or insignificant in the U.S. Table 1. 2008 U.S. Tax Receipts, by Source Source Federal Taxes Income Taxes Social Insurance Taxes Corporate Taxes Excise Taxes Estate Taxes Total, Federal Taxes State Taxes Sales Taxes Property Taxes Income Taxes Corporate Taxes Excise and Other Taxes Total, State Taxes Total, All Taxes Amount (Millions $) Percent of All Taxes 1,145,700 900,200 304,300 67,300 23,000 2,440,500 30.4% 23.9% 8.1% 1.8% 0.6% 64.7% 304,400 409,700 304,600 57,800 253,900 1,330,400 3,770,900 8.1% 10.9% 8.1% 1.5% 6.7% 35.3% 100.0% Source: U.S. Census Bureau (2010), except for federal estate tax data from Tax Policy Center (2008). 9 BOX 1. TAX ALTERNATIVES It is worthwhile to briefly consider tax types that are not currently important in the U.S. because these mechanisms are used in other countries or are central in various proposals to reform the U.S. tax system. We summarize five tax types here: 1. National sales tax. This would function similar to a state sales tax – as an addition to the retail price of certain products. A national sales tax would clearly be simpler and cheaper to administer than the current federal income tax. It would also encourage savings because, under most proposals, income that is not spent on taxable goods and services is not taxed. There are, however, two significant disadvantages to a national sales tax. First, it would create an incentive for black market exchanges to evade the tax. Second, it can be highly regressive – similar to the regressivity of state sales taxes. A national sales tax could be made less regressive, or even progressive, by providing rebates for low-income households. 2. National consumption tax. This is slightly different from a national sales tax. A household would pay the tax at the end of the year based on the value of its annual consumption of goods and services. Consumption can be calculated as total income less money not spent on goods and services (i.e., invested or saved). Again, a consumption tax would promote savings by exempting it from taxation. A consumption tax could also be designed to be progressive by taxing different levels of consumption at different marginal rates. 3. Value added tax. Most developed countries levy some form of value added tax (VAT). A VAT is levied at each stage in the production process of a product, collected from manufacturers according to the value added at each stage. Thus, the tax is not added to the retail price but incorporated into prices, similar to the way excise taxes become embedded into the price of products. Compared to a national sales tax, a VAT reduces the likelihood of black markets. 4. Wealth taxes. While the U.S. tax system includes local property taxes and, at least for a while, estate taxes, there is no tax on holdings of other assets such as corporate stocks, bonds, and personal property. Several European countries, including Sweden, Spain, and Switzerland, have instituted an annual wealth tax. A wealth tax could be very progressive by setting high rates and becoming effective only at significant wealth levels. 5. Environmental taxes. These are levied on goods and services in proportion to their environmental impact. One example is a carbon tax, which taxes products based on the emissions of carbon attributable to their production or consumption. The rationale of environmental taxation is that it encourages the use and development of goods and services with reduced environmental impacts. Like other taxes on goods and services, environmental taxes can be regressive – suggesting that environmental taxes need to be combined with other progressive taxes or rebates for low-income households. Among developed countries, the U.S. collects the smallest share of tax revenues from environmental taxes (OECD, 2010). 10 III. A BRIEF HISTORY OF TAXATION IN THE U.S. 10 Before the Federal Income Tax The tax mechanisms used during first 150 years or so of U.S. tax history bears little resemblance to the current system of taxation. First, the U.S. Constitution restricted “direct” taxation by the federal government – meaning taxes directly on individuals. Instead, the federal government relied on indirect taxes including taxes on imports (tariffs) and excise taxes. Tariffs were the major source of U.S. government receipts from the beginning of the nation up to the early 1900’s. For example, in 1800 custom duties comprised about 84% of government receipts (U.S. Census Bureau, 1960). Internal federal revenue collections (which exclude tariffs on imports) as recently as the early 20th century were primarily derived from excise taxes on alcohol. In 1900 over 60% of internal revenue collections came from alcohol excise taxes with another 20% from tobacco excise taxes. Another important difference is the scale of government taxation and expenditures relative to the entire economy. Government spending is currently a major portion of the total U.S. economy – in 2010 government expenditures and investment at all levels comprised about 20% of total economic output. In the late 1800s government expenditures were responsible for only about 2% of national output (earlier data on national output are not available). The role of government has become more prominent as a result of expansion of military activity and an increase in the provision of public services. Consequently an overall trend of increasing taxation is evident, although we’ll see that this trend has recently stabilized or reversed. The Constitutional framers were wary of a government’s power to tax. Taxation of the American Colonies by a distant and corrupt England was a driving force behind the American Revolution. Consequently, they believed in decentralized taxation and delegated most public revenue collection to localities, which relied primarily on property taxes. During peacetime the federal government was able to meet its expenses through relatively modest excise taxes and tariffs. During times of war, such as the War of 1812, federal taxes were temporarily raised to finance the war or pay down the ensuing debts. Once the financial crisis passed, taxes were reduced in response to public opposition to high tax rates. Like previous wars, the Civil War initiated an increase in both excise tax and tariff rates. Government revenue collections increased by a factor of seven between 1863 and 1866. Perhaps the most significant tax policy enacted during the Civil War was the institution of the first national income tax. Concerns about the legality of the tax, considering the Constitution’s prohibition of direct taxation, were muted during the national emergency. The income tax rates were low by modern standards – a maximum rate of 10% along with generous exemptions meant that only about 10% of households were subject to any income tax. Still, the income tax generated over 20% of federal revenues in 1865. After 10 The history of taxation is primarily derived from Brownlee (1996). 11 the war, few politicians favored the continuation of the income tax, and in 1872 it was allowed to expire. The impetus for the modern federal income tax rests not with a wartime emergency but with the Populist movement of the late 1800s. The internal tax system in place at the time, based primarily on excise taxes on alcohol and tobacco, was largely regressive. The Populists revived interest in an income tax as a means to introduce a progressive tax based on ability to pay. They saw it as a response to excessive monopoly profits and the concentration of wealth and power. In other words, the tax was not envisioned as a means to generate significant additional public revenue but as a vehicle of social justice. A federal income tax, with a large exemption of $4,000, was instituted in 1894 but the Supreme Court ruled it unconstitutional in 1895. Over the next couple of decades proposals were made for a constitutional amendment to establish a federal income tax. While these attempts were defeated, support for federal income taxation gradually increased. Eventually, in 1913 the 16th Amendment was ratified creating the legal basis for the federal income tax. While the initial income tax was progressive, it was less radical than many desired. In fact, many conservatives expressed guarded support for the measure to prevent a more significant tax. While the income tax was targeted towards the wealthy – in the first few years only about 2% of households paid any income tax – tax rates of only 1%-7% prevented it from generating significant revenues. “...virtually none of the income tax proponents within the government believed that the income tax would become a major, yet alone the dominant, permanent source of revenue within the consumption-based federal tax system.” (Brownlee, 1996, p. 45) These views were to quickly change as the nation required a dramatic increase in revenues to finance World War I. The Growth of Direct Taxation Rather than relying on increases in excise taxes and tariffs to finance World War I, the administration of Woodrow Wilson transformed the income tax framework laid down just a few years previously. Desiring both to raise additional revenue and enforce social justice, the top marginal rate increased dramatically from 7% in 1915 to 67% in 1917 (IRS, 2002). Corporate taxes also became an important revenue source, accounting for over one-quarter of internal revenue collections in 1917. In 1916 the estate tax was created, not necessarily to generate large revenues but as another instrument of progressive taxation. Unlike previous wars, much of the tax system laid down during World War I remained in place after the war. In the period from 1910 to 1925 tariffs fell from about half of government receipts to less than 15%. Meanwhile the new corporate and individual 12 income taxes made up nearly half of government receipts in the mid 1920s. The level of excise tax collections dropped significantly, especially during the years of Prohibition when alcohol excise taxes virtually disappeared. The Great Depression, of course, caused a significant decline in federal receipts. In 1932 tax rates were increased in an attempt to boost federal revenue. Franklin Roosevelt, in the years leading up to World War II, presented progressive taxation as a key element of the New Deal. However, the most significant measure enacted during this period was the creation of old-age insurance. Prior to national social insurance programs, poverty was the common state of the elderly (Skidmore, 1999). By the 1930s, several European countries had already instituted programs of social insurance. Germany was the first to establish old-age and survivors pensions in 1889 (Peterson, 1999). The Great Depression finally motivated policy makers in the U.S. to enact similar legislation. Rather than funding Social Security programs through increases in income, or other, taxes, the funding mechanism was a separate tax, split equally between employers and employees. All employees covered by the system 11 contributed and received benefits regardless of their income. This design was intended to protect the system from political attack. As everyone who pays into the system receives benefits, Social Security is not considered “welfare” that is allocated to only a segment of the population. Also, because Social Security is a separate tax, contributors view their old-age payments as entitlements and oppose attempts to weaken the program. This design has so far proved very successful – Social Security is often called the “third rail” of American politics (i.e., touch it and you die). World War II created yet another emergency situation requiring additional revenues. Similar to Woodrow Wilson during World War I, President Franklin Roosevelt sought to raise revenues primarily from higher taxes on corporations and high-income households. Roosevelt went so far as to state that: “In this time of grave national danger, when all excess income should go to win the war, no American citizen ought to have a net income, after he has paid his taxes, of more than $25,000.” (Brownlee, 1996, p. 91) Roosevelt was unable to obtain enough Congressional support to enact his most progressive proposals. The ensuing compromise did produce a more progressive federal income tax but it also became levied on more households. Personal exemptions were reduced by half between 1939 and 1942 – meaning the income tax reached well into the middle class for the first time. The taxable income subject to the highest marginal rate dropped from $5 million in 1941 down to $200,000 in 1942. Also, the top marginal tax rate reached a record high of 94% in 1944. Another change during World War II was withholding federal taxes from an employee’s paycheck rather than requiring payment of 11 While Social Security has expanded over the years to cover more employees, all workers are not currently covered by the system. For example, about one-quarter of state and local government employees are not included in the system (Peterson, 1999). 13 taxes due at the end of the year. These, as well as other, changes produced a dramatic shift in the structure of federal taxation: “Under the new tax system, the number of individual taxpayers grew from 3.9 million in 1939 to 42.6 million in 1945, and federal income tax collections over the period leaped from $2.2 billion to $35.1 billion. By the end of the war nearly 90 percent of the members of the labor force submitted income-tax returns, and about 60 percent of the labor force paid income taxes. … At the same time, the federal government came to dominate the nation’s revenue system. In 1940, federal income tax had accounted for only 16 percent of the taxes collected by all levels of government; by 1950 the federal income tax produced more than 51 percent of all collections. Installation of the new regime was the most dramatic shift in the nation’s tax policies since 1916.” (Brownlee, 1996, p. 96-97) As in the period after World War I, much of the new tax structure instituted during World War II remained in place after the war. Both major political parties expressed support for a progressive but broad income tax, relatively flat tax rates on corporate profits, and social insurance taxes that were basically regressive. Public support for the existing tax system was boosted by patriotic feelings and broad-based economic growth after the war. Changes to the tax system between the end of World War II and the 1980’s were generally minor. The Social Security tax occasionally increased as more people were receiving benefits. The initial tax rate of 2% (1% each for employers and employees) had increased to 6.13% by 1979. The Medicare and Medicaid programs were established in the 1960s. Across-the-board tax cuts in 1964 reduced marginal rates for both low- and high-income households (the top marginal rate fell from 91% in 1963 to 70% in 1965). Still, government continued to become a more significant portion of the entire economy in the decades after World War II. Total government expenditure and investment increased gradually from less than 18% of GDP in 1946 to over 22% by the mid 1970s. From the “Reagan Revolution” to the Bush Tax Cuts The general stasis of the federal tax system ended in the 1980s with the passage of several important tax reforms. Ronald Reagan was elected president in 1980 on a platform of smaller government and lower taxes. The Economic Recovery Tax Act of 1981 (ERTA) enacted the largest tax cut in American history 12 and inspired tax cutting by many other nations in the 1980s. The supply-side rationale behind ERTA’s sharp reduction in tax rates, particularly on high-income households and capital, was that greater incentives would motivate increased investment and economic activity. The ensuing economic growth and consequent tax revenue growth would, in theory, more than offset the revenue reductions as a result of the tax cuts. Thus, the theory was that tax cuts could actually produce an increase in federal revenues and address the growing federal budget deficit as well. ERTA phased in a reduction in the top tax rate from 70% to 50%, enacted several corporate tax cuts, and indexed many tax parameters to inflation (such as personal exemptions and deductions). 12 When measured in constant dollars (adjusted for inflation). 14 Analysis suggests that, in reality, ERTA resulted in the largest reduction in federal revenues of any tax bill since World War II (Tempalski, 1998). The federal budget deficit continued to grow. The very next year, in 1982, the largest peacetime tax increase was passed (Martin, 1991). The act repealed some of the more revenue-reducing provisions of ERTA, such as accelerated depreciation reductions for corporations, and closed several corporate loopholes in the tax code. Social Security reforms were enacted in 1983 that increased Social Security tax rates and initiated taxation of some benefits. Reagan continued to push for further tax reforms, leading to the Tax Reform Act of 1986 – considered to be the most comprehensive revision of the tax code since the 1950s (Petska and Strudler, 1999). This act reduced top income tax rates even further – from 50% in 1986 to 28% in 1988. Among many other changes, it also lowered the top corporate tax rate from 46% to 34%. Clearly, the “Reagan revolution” is an important era in U.S. tax history, but many people misinterpret it as a period where the size of the federal government was drastically reduced and taxes cut significantly. Despite the two major tax cuts during Reagan’s terms, federal revenue collections increased at nearly the same pace as national output (total federal revenues increased about 76% from 1980-1988 while GDP increased 83%). The actual changes were more evident in the distribution of federal revenues than their total level. The share of revenues from both individual and corporate taxation fell (by 9% and 16% respectively) while the portion from social insurance taxes increased by 38%. As the individual and corporate taxes are progressive, while social insurance taxes are regressive, the outcome was a decrease in the overall progressivity of the federal tax system. Specific changes within the individual income tax code exacerbated the decline in progressivity. The Reagan era failed to control the growing federal deficit. The annual budget deficits of the federal government tripled during the 1980s 13 (OMB, 2003). Partly to raise additional revenue to try to reduce deficits, the first President Bush reneged on his campaign promise of “no new taxes” and agreed to a compromise tax proposal in 1990 that raised the top marginal tax bracket to 31%. President Clinton reinstated additional progressivity in 1993 by creating the 36% and 39.6% individual tax brackets. In 1993, the corporate tax rate was increased slightly to 35%. These changes produced an increase in the progressivity of federal taxes. The most recent important tax legislation was the $1.35 trillion Bush tax cut passed in 2001. The major provisions of this act include lowering individual income tax rates across-the-board, scheduling repeal of the estate tax in 2010, and increasing the amount employees can contribute under various programs for retirement purposes. Many of the bill’s provisions are “back-loaded,” meaning the tax reductions are phased in over time with most of the tax reduction occurring in the future. For example, the top marginal bracket fell from 39.6% in 2001 to 38.6% in 2002 but eventually fell to 35.0% in 2006. 13 This is based on the “on-budget” calculations. The on-budget accounting excludes the Social Security trust fund as well as other minor balances. 15 The Bush tax cut reduced the overall progressiveness of the federal income tax as highincome taxpayers received a disproportionate share of the total cuts (CTJ, 2001). A somewhat smaller tax cut was passed in 2003 that, among other changes, accelerated scheduled tax rate decreases and lowered the maximum tax rate on capital gains and dividends. Most recently, the 2009 American Recovery and Reinvestment Act of 2009 instituted or expanded various tax credits such as a payroll tax credit of $400 per worker and an expanded tax credit for college tuition. IV. Summary Data of U.S. Tax History Until quite recently, tax collections have tended to increase over time; paralleling the increase in the size of the federal government. We see in Figure 1 that federal tax revenues have grown considerably during the 20th century, even after adjusting for inflation. A large increase in federal tax collections occurred during World War II, with relatively consistent growth after about 1960. However, notice occasional declines in federal tax revenues, due either to recessions or to major tax code changes. The growth Figure 1. Tax Collections, 1913-2009 (All values in 2009 dollars) 14 14 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. All data from various editions of the Statistical Abstract of the United States and U.S. Census Bureau (1960). 16 of state and local tax collections, by comparison, has been steadier with less fluctuation. The reason is that state and local tax revenues are derived primarily from property and sales taxes, which vary less than income (particularly corporate income) during business cycles. Another way to illustrate the growth of federal taxation is to measure it relative to national economic output. In Figure 2 we plot federal and state and local tax collections as a share of GDP. Three facts are evident from Figure 2. First, total tax collections have generally grown as a percentage of GDP over the 20th century. Again, the largest leap occurred during World War II, but some additional growth is evident after the war as well. The second fact is that federal tax revenues now substantially exceed state and local tax revenues. While World War II solidified the federal government as the primary tax collector in the U.S., note that this trend began prior to the war. Finally, note the decline in federal taxes as a percentage of GDP since 2000. This is a result of both economic recessions and declines in federal tax rates. In fact, federal taxes as a percentage of GDP were lower in 2009 than in any year since the 1940s. Figure 2. Tax Collections as a Percentage of GDP, 1913-2009 15 As federal revenues grew during the 20th century, the composition of taxation has changed considerably. We see in Figure 3 that at the beginning of the century federal taxation was dominated by excise taxes. Except for a revival of excise taxes during the Depression Era, their importance has generally diminished over time. Corporate taxes became the most significant source of federal revenues for the period 1918-1932. After a period of higher corporate taxes during World War II, corporate taxes have generally diminished in significance relative to other forms of federal taxation. Personal income 15 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. 17 taxes became the largest source of federal revenues in 1944 and have remained so. Since World War II, income taxes have consistently supplied between 40-50% of federal revenues. Since about 1950, social insurance taxes have increased their share of federal revenues from about 10% up to nearly 40%. In fact, social insurance taxes may soon exceed personal income taxes as the largest source of federal revenues. Figure 3. Composition of Federal Taxes, 1913-2009 The composition of state and local taxes, with its increased reliance on sales and property taxes, differs from the composition of federal taxes. Of course, each state has a different tax system – some states have no income and/or sales taxes, and tax rates can differ significantly across states. In this module, we combine tax data for all states rather than presenting a state-by-state analysis. Figure 4 presents the composition of state and local taxes over the period 1945-2009. The two major trends that are evident are a decline in the importance of property taxes and an increase in the importance of personal income taxes except for a recent reversal of these trends in the last few years. While property taxes were the primary source of state and local revenues until the 1970s, sales taxes became the major source of revenues until 2008, when property taxes again became the major revenue source. 18 Figure 4. Composition of State and Local Taxation, 1945-2009 V. THE DISTRIBUTION OF TAXES IN THE UNITED STATES Tax Incidence Analysis There are basically two ways to analyze how the tax burden is distributed. The easiest way is to measure the taxes directly paid by entities, such as households or businesses, classified according to criteria such as household income, business profit levels, etc. These data can be obtained directly from aggregate tax return data published by the IRS and from reports from other government agencies. This approach considers only who actually pays the tax to the government. Thus, it would allocate corporate taxes to corporations, excise taxes to manufacturers, sales taxes to consumers, etc. The second approach, called tax incidence analysis, is more complex yet more meaningful. While taxes are paid by various entities other than individuals, such as corporations, partnerships, and public service organizations, the burden of all taxes ultimately fall on people. The final incidence of taxation is contingent upon how a specific tax translates into changes in prices and changes in economic behavior among consumers and businesses: “Tax incidence is the study of who bears the economic burden of a tax. More generally, it is the positive analysis of the impact of taxes on the distribution of welfare within a society. It begins with the very basic insight that the person who 19 has the legal obligation to make a tax payment may not be the person whose welfare is reduced by the existence of the tax. The statutory incidence of a tax refers to the distribution of those legal tax payments – based on the statutory obligation to remit taxes to the government. ... Economic incidence differs from statutory incidence because of changes in behavior and consequent changes in equilibrium prices. Consumers buy less of a taxed product, so firms produce less and buy fewer inputs – which changes the net price or return to each input. Thus the job of the incidence analyst is to determine how those other prices change, and how those price changes affect different groups of individuals.” (Metcalf and Fullerton, 2002, p. 1) Tax incidence analysis has produced a number of generally accepted conclusions regarding the burden of different tax mechanisms. Remember, for example, that the payroll tax on paper is split equally between employer and employee: “So, who really pays the payroll tax? Is the payroll tax reflected in reduced profits for the employer or in reduced wages for the worker? ... there is generally universal agreement that the real burden of the tax falls almost entirely on the worker. Basically, an employer will only hire a worker if the cost to the employer of hiring that worker is no more than the value that worker can add. So, a worker is paid roughly what he or she adds to the value of production, minus the payroll tax; in effect, the whole tax is deducted from wages. ... to repeat, this is not a controversial view; it is the view of the vast majority of analysts...” (Krugman, 2001, p. 43) The most common assumption made regarding the allocation of corporate taxes is that the burden of these taxes falls almost exclusively on the owners of capital investments. Given the mobility of capital, the burden is not limited to owners of corporate capital but extends to owners of all capital. 16 This result is primarily a theoretical finding – in reality some portion of the corporate tax burden likely falls on workers (through lower wages) and consumers (through higher prices). Excise taxes, although directly paid by manufacturers, are generally attributed entirely to consumers according to their consumption patterns. 17 This result is based on an assumption of perfect competition in the affected industries. Real-world markets, however, are not perfectly competitive. The actual incidence of excise taxes will depend on the degree of competition in an industry. For example, imperfectly competitive industries with upward-sloping supply curves imply that prices increase by less than the tax and that a portion of excise taxes is borne by businesses. 18 16 See summary in Metcalf and Fullerton (2002). See CBO (2008). 18 See Fullerton and Metcalf (2002) for a summary of incidence assumptions and analyses for different types of taxes. 17 20 The burden of sales taxes is generally assumed to fall directly on consumers who buy the taxed goods and services. Again, this is a simplifying assumption – in reality some portion of sales taxes filters to corporate owners, other capital owners, and workers. Personal income taxes paid by households are directly attributed to those households paying the tax. Estate tax burdens fall on the heirs paying the tax. Finally, property tax burdens are generally assumed to fall on property owners although the burden can be passed on renters (some analysts attribute property taxes more broadly to owners of capital). So, for several types of tax mechanisms (personal income, sales, excise, and estate taxes), data on direct tax payments is analogous to tax incidence. However, for other taxes (payroll, corporate, and to a lesser extent property taxes) the direct data on tax payments will differ from the ultimate burden of the tax. Using Effective Tax Rate Data to Determine Tax Progressivity As mentioned before, a tax is progressive if the percentage of income a person pays for the tax increases as income increases. Thus, we can determine whether a tax is progressive or regressive by looking at a table showing the effective tax rates for a particular tax for people in different income categories. If effective tax rates increase (decrease) with increasing income, then the tax is progressive (regressive). Table 2 shows the percentage of income people in each adjusted gross income (AGI) category paid in federal income taxes in 2008, the most recent data available. We see that effective tax rates for the federal income tax tend to increase with increasing income (although not always). For taxpayers making less than $100,000 AGI per year, the Table 2. Distribution of Federal Income Taxes, 2008 AGI Category Percent of Returns 16.7 Average AGI $5,099 Average Income Taxes $177 Effective Income Tax Rate 3.5% 16.0 $14,927 $513 3.4% 13.0 $24,798 $1,421 5.7% 18.0 $39,126 $2,808 7.2% 13.5 $61,470 $5,246 8.5% 8.2 9.7 2.4 0.4 $86,421 $133,208 $285,735 $679,576 $8,037 $16,903 $55,984 $163,513 9.3% 12.7% 19.6% 24.1% 0.2 $3,349,101 $780,550 23.3% $1-$10,000 $10,000-$20,000 $20,000-$30,000 $30,000-$50,000 $50,000-$75,000 $75,000 - $100,000 $100,000-$200,000 $200,000-$500,000 $500,000$1,000,000 More than $1,000,000 21 effective federal income tax rate averages less than 10% of income. For those making more than $200,000 per year, the federal income tax averages more than 20% of income. The federal income tax is clearly progressive because those with higher incomes generally pay a larger share of their income for the tax. For a regressive tax, effective tax rates tend to decrease as income increases. If effective tax rates are constant at different income levels, then a tax is proportional. Looking at effective tax rates by income categories can normally determine whether a tax is progressive or regressive. However, there may be some cases where effective tax rates do not follow a consistent pattern across income levels. For example, suppose that effective taxes first increase but then decrease as we move up the income spectrum. Another limitation with data on effective tax rates is that this approach does not tell us the degree of progressivity or regressivity. We might not be able to determine whether one tax is more progressive than another or whether a particular tax becomes more or less progressive over time. Researchers have come up with several tax indices that measure the progressivity of a tax as a single number. These indices allow direct comparisons across different tax types and across time. The most common tax progressivity index is discussed in Box 2. Effective Tax Rates in the United States Data on the distribution of taxes in the U.S. are available from several sources. The government sources that publish data on tax distribution include the Internal Revenue Service (IRS), the Joint Committee on Taxation (JCT), the Congressional Budget Office (CBO), and the Office of Tax Analysis within the U.S. Treasury. The IRS data are the most detailed but focus on federal income and estate taxes. The IRS publishes data on corporate taxes but does not conduct tax incidence analysis. The JCT occasionally conducts tax incidence analyses but only on the federal income tax, payroll taxes, and federal excise taxes. The CBO adds the incidence of federal corporate taxes to their analyses but still omits the federal estate tax and all state and local taxes. The only source for tax incidence data for all taxes in the U.S. is Citizens for Tax Justice (CTJ), a non-profit organization. CTJ uses data from government sources but has developed its own models of tax incidence. Comparison of tax progressivity data from CTJ with data from the federal sources listed above indicates that their results are generally similar to the government’s results and not biased in either direction (Roach, 2003). 22 BOX 2. MEASURING TAX PROGRESSIVITY – THE SUITS INDEX The Suits Index, developed by Daniel Suits in the 1970s (Suits, 1977), calculates a single number that measures tax progressivity. The approach basically compares the cumulative share of income received by taxpayers, order from lowest to highest, to their cumulative share of taxes paid. For a progressive (regressive) tax, the share of taxes paid will tend to be less (more) than the share of income as we move up the income spectrum. Other tax progressivity indices have been developed but the Suits Index remains the most widely used approach (Anderson, et al., 2003). While the calculation details are not presented here, the Suits Index is a number ranging between –1 and +1. A negative Suits Index means that the tax is regressive while a positive index indicates a progressive tax (with a value of zero for a proportional tax). The Suits Index can be used to compare the degree of progressivity of different tax types as well as determine whether a tax becomes more or less progressive over time. The Suits Index has been used to estimate the progressivity of different tax types in the U.S. for 2007 (Roach, 2010). Table 2.1 shows that the U.S. tax system contains a mixture of progressive and regressive taxes. The federal estate tax is the most progressive tax while the federal corporate and income taxes are also progressive. On the other hand, federal excise taxes are the most regressive. Federal social insurance taxes and overall state and local taxes are also regressive. When all federal taxes are considered, the Suits Index of +0.18 indicates that federal taxation is progressive. The entire U.S. tax system is also progressive, but the recent Suits Indices of +0.05 and +0.06 are closer to a value of zero (a proportional tax) than just the federal tax system. Table 2.1. Suits Index Estimates of the U.S. Tax System, 2007, by Tax Type1 Tax Type Federal Income Federal Social Insurance Federal Excise Federal Corporate Federal Estate and Gift State and Local Total Federal All U.S. Taxes (2001 data) All U.S. Taxes (2004 data) All U.S. Taxes (2009 data) Suits Index +0.42 -0.20 -0.31 +0.51 +0.63 -0.12 +0.18 +0.09 +0.05 +0.06 __________________ 1 – The Suits Index for the federal estate and gift tax is based upon 2008 data. 23 Table 3 presents the tax distribution data from CTJ for 2009. We see that while the federal tax system is progressive, the state and local tax system is, on average, regressive. Overall, the tax system in the U.S. is progressive, although the rate of progressivity levels off at upper income levels and actually reverses at the highest income level in Table 3. Table 3. Effective Tax Rates, 2009 19 Effective Tax Rates Income Group Average Income Lowest 20% $12,400 Second 20% $25,000 Third 20% $40,000 Fourth 20% $66,000 Next 10% $100,000 Next 5% $141,000 Next 4% $245,000 Top 1% $1,328,000 ALL $68,900 Federal Taxes 3.6% 8.7% 13.9% 17.2% 19.0% 20.4% 21.3% 22.3% 18.0% State & Local Taxes 12.4% 11.8% 11.3% 11.3% 11.1% 10.8% 10.2% 8.4% 10.6% All Taxes 16.9% 20.5% 25.3% 28.5% 30.2% 31.2% 31.6% 30.8% 28.6% Tax Progressivity over Time Consistent data are generally not available to determine how the entire tax burden in the U.S. has shifted over time. Most analyses are limited to one, or a few, tax types. Further, interest groups can interpret the available data to support their particular agendas. For an illustration about how the same tax data can be used to support different claims, see Box 3. Analysis of tax progressivity over time indicates that the federal tax system is about as progressive now as it was in the late 1970s (Roach, 2010). The progressivity of the federal tax system declined during the early 1980s, rose in 1987 (the year following the passage of the Tax Reform Act of 1986), either remained stable or rose slightly up to the mid-200s, and decreased slightly since the mid-200s. Complete data on the distribution of state and local taxes are available from Citizens for Tax Justice for 1995, 2002, 2007, and 2009, with Suits Indices of -0.11, -0.07, -0.12, and -0.07 respectively. Thus the available data suggest no obvious overall trend in the regressivity of state and local taxes. The unavailability of consistent data on the distribution of state and local taxes makes determination of the trends in the overall U.S. 19 Data from CTJ, 2010. 24 tax system difficult to determine. As Table 2.1 indicated, total taxes declined in progressivity from 2001 to 2004, and then stayed about the same from 2004 to 2009. BOX 3. INTERPRETING TAX PROGRESSIVITY DATA Has the federal income tax burden on the very wealthy been increasing or decreasing in recent decades? Data published by the CBO reveals that the percent of federal income taxes paid by the highest-income taxpayers has increased steady over the past few decades. In 1979, the top 1% of taxpayers paid about 18.3% of all federal income taxes. In 2007, the top 1% of taxpayers paid over 39.5%. Clearly, these data suggest that the federal income tax has become much more progressive since 1979. However, these statistics represent an incomplete analysis. Specifically, it fails to consider how the proportion of income accruing to the top 1% has changed over the same time period. The increasing tax share paid by high-income taxpayers may be a function of an increase in income, rather than a change in the tax system. In other words, if the share of all income received by the top 1% increased, we would naturally expect that their share of taxes paid would also increase without any changes in the underlying progressivity of the tax system. Income statistics indicate that the share of income going to the top 1% of taxpayers has also increased significantly since 1979. The top 1% of taxpayers received less than 9.2% of income in 1979 but more than 19.4% in 2007. Based on this fact alone, we would expect the top 1% to be paying a greater share of all federal income taxes. So, has the federal income tax burden on the top 1% increased or decreased since 1979? We can combine the tax and income data for a more complete analysis. The share of income going to the top 1% increased by a factor of 2.1 between 1979 and 2007. Meanwhile, their share of taxes paid has increased by a factor of 2.2. This suggests that the share of taxes paid by the top 1% has risen by about as much as much as their share of income – indicating a relatively stable degree of tax progressivity in the federal income tax – a dramatically different conclusion had we only considered data on tax shares! 25 References Brownlee, W. Elliot. 1996. Federal Taxation in America. University of Cambridge Press: Cambridge. Chaptman, Dennis. 2003 “States' Budget Troubles Worsening, Report Finds,” Milwaukee Journal Sentinel, Feb. 5, 2003. Citizens for Tax Justice, Institute on Taxation & Economic Policy. 2003a. “Who Pays? A Distributional Analysis of the Tax Systems in All 50 States, 2nd Edition,” January 2003, http://www.itepnet.org/wp2000/text.pdf. Citizens for Tax Justice. 2010. “All Americans Pay Taxes,” April 15, 2010. http://www.ctj.org/pdf/taxday2010.pdf. Citizens for Tax Justice. 2003b. “Final Tax Plan Tilts Even More Towards Richest,” June 5, 2003 press release, http://www.ctj.org/pdf/sen0522.pdf. Citizens for Tax Justice. 2002. “White House Reveals Nation’s Biggest Problems: The Very Rich Don’t Have Enough Money & Workers Don’t Pay Enough in Taxes,” December 16, 2002 press release, http://www.ctj.org/pdf/flat1202.pdf. Citizens for Tax Justice. 2001. “Final Version of Bush Tax Plan Keeps High-End Tax Cuts, Adds to Long-Term Cost,” May 26, 2001 press release, http://www.ctj.org/html/gwbfinal.htm. Congressional Budget Office, “Effective Federal Tax Rates, 2005,” December 2008. Fullerton, Don, and Gilbert E. Metcalf, 2002. “Tax Incidence,” National Bureau of Economic Research Working Paper 8829. IRS (Internal Revenue Service). Various Years. Statistics of Income, Individual Income Tax Returns. Washington, D.C. IRS (Internal Revenue Service). 2002. “Personal Exemptions and Individual Income Tax Rates, 1913-2002.” Statistics of Income Bulletin Data Release, June 2002. Johnson, Charles M. 2002. “Finding their Balance?” Missoulian, December 8, 2002.Joint Committee on Taxation. 2001. “Updated Distribution of Certain Federal Tax Liabilities by Income Class for Calendar Year 2001,” JCX-65-01.Krugman, Paul. 2002. “For Richer,” The New York Times, October 20, 2002, section 6, page 62. Krugman, Paul. 2001. Fuzzy Math: The Essential Guide to the Bush Tax Cut Plan, W.W. Norton & Company: New York. 26 Martin, Cathie J. 1991. Shifting the Burden: The Struggle over Growth and Corporate Taxation. The University of Chicago Press: Chicago. Metcalf, Gilbert E. and Don Fullerton. 2002. “The Distribution of Tax Burdens: An Introduction,” National Bureau of Economic Research Working Paper 8978. OECD (Organisation for Economic Co-operation and Development). 2010. “More Information on Environmentally Related Taxes, Fees and Charges,” http://www2.oecd.org/ecoinst/queries/index.htm. OMB (Office of Management and Budget). 2003. “Historical Tables, Budget of the United States Government, Fiscal Year 2004.” Washington, D.C. Peterson, Wallace C. 1999. The Social Security Primer: What Every Citizen Should Know. M.E. Sharpe: Armonk, NY. Petska, Tom, and Mike Strudler. 1999. “The Distribution of Individual Income and Taxes: A New Look at an Old Issue.” Paper presented at the 1999 American Economics Association conference, January 3-5, 1999, New York, http://www.irs.gov/taxstats/article/0,,id=112309,00.html. Roach, Brian. 2010. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 10-07, December 2010. Roach, Brian. 2003. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 03-10, October 2003. Skidmore, Max J. 1999. Social Security and Its Enemies. Westview Press: Boulder, CO. Tax Policy Center. 2010. “Wealth Transfer Taxes: Who Pays the Estate Tax?” The Tax Policy Briefing Book, http://www.taxpolicycenter.org/briefing-book/keyelements/estate/who.cfm. Tax Policy Center. 2008. “Estate Tax Returns and Liability Under Current Law and Various Reform Proposals, 2008-2018,” Table T08-0264, October 20, 2008. Tempalski, Jerry. 1998. “Revenue Effects of Major Tax Bills.” Office of Tax Analysis Working Paper 81, December 1998. U.S. Census Bureau. 2003. “Historical Income Tables - Income Equality, Table IE-1,” http://www.census.gov/hhes/income/histinc/ie1.html. U.S. Census Bureau. 2010. The 2010 Statistical Abstract of the United States. Washington, D.C. 27 U.S. Census Bureau. Various Years. Statistical Abstract of the United States. Washington, D.C. U.S. Census Bureau. 1960. Historical Statistics of the United States, Colonial Times to 1957. Washington, D.C. 28 MODULE SUMMARY • The overall tax system in the United States is progressive, meaning that effective tax rates tend to increase as income increases. Progressive taxation is based on the view that higher-income taxpayers can pay higher tax rates without having to forego life’s basic necessities. Progressive taxation can also redress economic inequalities and collect a given level of revenue while maintaining the maximum level of economic growth. • The federal income tax is the most complicated and debated tax in the U.S. tax system. The federal income tax is progressive, with increasing marginal tax rates. Federal income taxes are calculated based on taxable income, which is less than total income because various exemptions and deductions are allowed. • The federal tax system in the U.S. also includes social insurance, corporate, excise, estate, and gifts taxes. Social insurance and excise taxes are regressive while corporate, estate, and gift taxes are progressive. The U.S. tax system also includes state and local taxes, primarily sales, income, and property taxes. • Nearly 70% of the taxes levied in the U.S. are collected at the federal level. The largest federal tax is the income tax, closely followed by social insurance taxes. The most significant non-federal tax is property taxes, followed by sales and income taxes. • Up until the early 1900s, the U.S. tax system primarily relied on excise taxes and tariffs for public revenues. The 16th Amendment, ratified in 1913, created the legal basis for federal income taxation, which up to that point had been prohibited under the Constitution. • Both World Wars led to significant changes in the structure and overall magnitude of taxes in the U.S. By the end of World War II, U.S. taxes were broad-based but progressive and dominated by federal-level taxation. • Tax cuts passed during the Reagan Administration in the 1980s were based on the theory that lower tax rates would spur economic growth, leading to a net increase in tax revenues. This theory was not supported by the evidence, eventually leading to tax increases in the early 1990s. The Bush tax cuts passed in 2001 and 2003 have made federal taxes less progressive. • Tax revenues in the U.S. increased dramatically during the 20th century, even after adjusting for inflation. When measured as a percentage of GDP, tax revenues grew significantly during World War II, grew at a slower pace afterwards, and leveled off recently at around 30% of GDP. 29 • Measuring the distribution of taxes requires tax incidence analysis, which determines the ultimate burden of a tax on taxpayers. Tax incidence analysis generally concludes that social insurance taxes fall on workers, corporate taxes fall on the owners of capital, excise taxes fall on consumers, and property taxes are passed on to renters. • Effective tax rates measured by income level can be used to determine whether a particular tax is progressive or regressive. While the U.S. tax system contains both progressive and regressive taxes, the overall system is progressive. Recent data suggest that federal taxes are becoming less progressive while state and local taxes are becoming more regressive. 30 DISCUSSION QUESTIONS 1. Comment on the following statement: “The fairest type of tax system is one in which everyone pays the same rate of taxation, regardless of income.” Do you agree or disagree with the statement? Why? 2. Suppose you could set the overall effective tax rates across different levels of income. What do you think should be the appropriate effective tax rates for a household of four (two adults and two children) with an income of $25,000? An income of $60,000? An income of $100,000? An income of $500,000? Is the system you devise more or less progressive than the tax system currently in place in the U.S.? How does your system compare with others in your class? 3. The U.S. tax system is currently comprised of many different types of taxes (income, social insurance, corporate, sales, property, etc.). What reasons could be given to support the use of many different tax types in a nation? Do you think that a nation’s tax system should be comprised of many different types of taxes or just one type of tax? If you had to choose just one type of tax to levy in a nation, what type of tax would you choose? Why? 4. Comment on the following statement: “As long as a tax cut reduces taxes for everyone, then everyone will be better off as a result of the tax cut.” Do you agree with this statement? Why or why not? 5. Using the Internet or other sources, look up information about basic structure of the tax system in place in a country other than the United States. What differences are evident in that country’s tax system? Do you think that country has a more or less progressive tax system? Which nation’s tax system is preferable to you? Why? 6. Locate a recent news story about a proposal for a change to the tax system, either at the federal or state level. Summarize the proposed change. Would the change increase or decrease tax progressivity? Who would benefit most from the proposal? Who would be hurt the most from the proposal? Do you support the proposal? Why or why not? 31 ADDITIONAL RESOURCES • All the federal government agencies that work on tax issues maintain web sites that provide tax data and reports. The IRS’s Statistics of Income Bulletins, published four times a year, can be found dating back to 1998 at http://www.irs.gov/taxstats/article/0,,id=117514,00.html. The SOI Bulletins provide data analysis of primarily individual and corporate taxes. Publications produced by the Joint Committee on Taxation can be found at http://www.jct.gov/publications.html. Publications by the Congressional Budget Office related to tax issues, going as far back as the 1970s, are available at http://www.cbo.gov/publications/bysubject.cfm?cat=33. Finally, tax analysis by the U.S. Treasury Department, only dating back to 2001, can be found at http://www.treasury.gov/resource-center/tax-policy/Pages/default.aspx. • A large amount of tax-related data is published annually in the Statistical Abstract of the United States. Each year’s edition includes a chapter on state and local government finances and another chapter on federal government finances. The Census Bureau has recently added select historical editions of the Statistical Abstract dating as far back as 1878, although online availability is more complete for the first half of the 20th century than the latter half of the century (see http://www.census.gov/compendia/statab). • Citizens for Tax Justice publishes many other tax analyses besides those referenced in this module. Their web site is www.ctj.org. Two other non-profit organizations that conduct tax analysis are the Tax Policy Center, a joint venture of the Urban Institute and Brookings Institution, and the Center for Budget and Policy Priorities. The Tax Policy Center (www.taxpolicycenter.org) publishes several reports each month on a wide range of tax issues, including distributional impacts and public budget implications. The CBPP (www.cbpp.org) research focuses on “fiscal policy and public programs that affect low- and moderate-income families and individuals.” Similar to the Tax Policy Center, the CBPP conducts distributional analyses of current tax proposals. • For an opposing view on tax issues, the Tax Foundation (www.taxfoundation.org) publishes tax analyses that generally support lower overall taxes and conclude that the distributional impacts of recent tax cuts are fair. A similar organization, with a more activist agenda, is Americans for Tax Reform (www.atr.org). 32 KEY TERMS AND CONCEPTS Ability-to-pay principle: the idea that higher-income households and individuals should pay higher tax rates than lower-income taxpayers because they are more able to bear the tax without foregoing life’s basic necessities. Adjusted gross income (AGI): the total income of a household or individual minus certain out-of-pocket expenses such as retirement account contributions, student loan interest, tuition, and other allowable subtractions. AGI is calculated on one’s federal tax return. Effective tax rate: one’s total taxes paid divided by some measure of income, such as total income, adjusted gross income, or taxable income. Environmental taxes: taxes levied on a good or service based on the environmental impact of its production or consumption. Estate taxes: taxes on the transfer of large estates to beneficiaries. Excise taxes: taxes on the production, sale, or use of a particular commodity. Exemptions: an amount excluded from taxation based on the number of tax filers and dependents. Gift taxes: taxes levied on large gifts; gift taxes are designed to prevent taxpayers from avoiding estate taxes by giving away their assets while alive. Itemized deductions: certain expenses excluded from federal taxation, including mortgage interest, state taxes, gifts to charity, real estate taxes, and major medical expenses. A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Marginal propensity to consume: the proportion of a marginal income increase that is spent on consumption goods and services, as opposed to invested or saved. Marginal tax rates: a tax system where a single taxpayer can pay different tax rates on successive portions of income. National consumption tax: a federal-level tax paid on the dollar amount a household or individual spends each year on goods and services, calculated using either a single tax rate or marginal tax rates. National sales tax: a federal-level tax paid on the purchase of certain goods and services, calculated as a percentage of the selling price. 33 Perfect competition: an idealized market structure characterized by many informed small firms with no market power selling undifferentiated products and with complete freedom to enter or exit the market. Progressive tax: a tax in which the percentage of income one pays for the tax increases as one’s income increases. Proportional tax: a tax in which the percentage of income one pays for the tax is constant regardless of income level. Regressive tax: a tax in which the percentage of income one pays for the tax decreases as one’s income increases. Social insurance taxes: taxes paid to support social insurance programs such as Social Security, Medicare, and Medicaid. Standard deduction: a fixed amount of income excluded from federal taxation based on filing status (single, married, etc.). A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Suits index: an index developed by Daniel Suits in the 1970s to measure the overall progressivity or regressivity of a tax. Tariffs: taxes levied on imported goods and services. Tax incidence analysis: estimating the ultimate financial burden of various taxes on different categories of households by tracing a tax’s impact on market prices and the economic behavior of consumers and businesses. Taxable income: the amount of income used as the basis for determine one’s income taxes. For federal income taxes, taxable income is equal to adjusted gross income (AGI) minus allowable deductions and exemptions. Total income: the total income a household or individual receives from all sources Value-added tax: a tax levied at each stage in the production process of a good or service. Wealth taxes: taxes levied on the value of one’s assets such as real estate, investments, cash, and other personal property. 34
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What is the history of taxes in the United States?
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What factor is contributing most to the increased rate of colorectal cancer in young adults?
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Original article Global patterns and trends in colorectal cancer incidence in young adults Rebecca L Siegel, 1 Lindsey A Torre,1 Isabelle Soerjomataram,2 Richard B Hayes,3 Freddie Bray,2 Thomas K Weber,4,5 Ahmedin Jemal1 ►► Additional material is published online only. To view please visit the journal online (http://dx.doi.o rg/10.1136/ gutjnl-2 019-319511). 1 Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA 2 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France 3 Department of Population Health, New York University School of Medicine, New York, New York, USA 4 Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA 5 Department of Surgical Oncology, Northwell Health Cancer Institute, Great Neck, New York, USA Correspondence to Ms Rebecca L Siegel, American Cancer Society, Atlanta, GA 30303, USA; rebecca.siegel@cancer.org Received 22 July 2019 Revised 16 August 2019 Accepted 21 August 2019 Abstract Objective Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking. Design We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA). Results During 2008–2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with longterm data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)). Conclusion CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis. Introduction © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. To cite: Siegel RL, Torre LA, Soerjomataram I, et al. Gut Epub ahead of print: [please include Day Month Year]. doi:10.1136/ gutjnl-2019-319511 Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, with an estimated 1.8 million new cases in 2018.1 Global patterns vary widely and are strongly linked to human development index level, reflecting the adoption of western lifestyles that accompany economic transition and elevate risk. In general, CRC incidence is rising in low-income and middle-income countries but beginning to stabilise or decline in high-income countries, especially those that have implemented screening.2 However, accumulating evidence from studies Significance of this study What is already known on this subject? ►► Colorectal cancer (CRC) incidence rates in young adults (aged <50 years) are increasing in several countries, despite declining rates in older adults. The extent to which this pattern is occurring on a global scale is unknown. What are the new findings? ►► CRC incidence rates are uniquely increasing in young adults in nine high-income countries (Germany, USA, Australia, Canada, New Zealand, UK, Denmark, Slovenia and Sweden) across North America, Europe and Oceania where rates in older adults are stable or declining. Conversely, CRC declined in young adults in only three countries (Italy, Austria and Lithuania) compared with 11 countries in adults 50 and older. How might it impact on clinical practice in the foreseeable future? ►► Improving awareness of the marked increases in young-onset CRC incidence could facilitate more diligent assessment of cancer family history by primary care clinicians, as well as follow-up of symptoms in young individuals, many of whom are diagnosed at a late stage. These findings also highlight the need for research on early-life exposures in relation to colorectal carcinogenesis. of cancer registry data indicates that favourable overall trends are masking an increase in young-onset CRC in the USA,3–6 Australia7 8 and Canada.9 Although the absolute risk of CRC in adults younger than 50 years is low relative to older adults, disease trends in young age groups are a key indicator of recent changes in risk factor exposures and often foreshadow the future cancer burden.10 In addition to country-specific analyses, there are recent reports on early-onset CRC occurrence in seven high-income countries,11 in Europe12 and in 11 ‘industrialised’ countries (data through 2007).13 However, a comprehensive examination of contemporary trends on a global scale is lacking. We analysed high-quality longterm population-based data on CRC occurrence by age at diagnosis for 43 countries covering six continents. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 1 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 1 Age-standardised incidence rate during 2008–2012 for colorectal cancer among adults ages 20–49 years. Bar shading indicates trend in incidence rates based on 10-year average annual per cent change; red: statistically significant increase; blue: statistically significant decrease; grey: stable or insufficient number of cases for trend analysis (‡). Rate for Finland unavailable.*Rate based on data during 2008-2010.†Excludes Nunavut, Quebec, and Yukon.‡Excluded from trend analysis due to insufficient number of annual cases.¶Rate based on data during 2008-2011. Methods We obtained high-quality population-based annual incidence data for colon and rectal cancer diagnosed through 2012 from the Cancer Incidence in Five Continents (CI5plus) database of the International Association of Cancer Registries and the International Agency for Research on Cancer (IARC).14 The CI5plus database is compiled from cancer registry data worldwide using a process that ensures comparable information that meets high quality standards established by IARC. Specifically, on submission the data coding is verified, the format is standardised, and an editorial board conducts an evaluation based on three dimensions of quality: comparability, completeness and validity. (For more information about the database, see c i5.iarc. fr/CI5-XI/Default.aspx.) The population coverage of registries included in CI5 may be national or subnational. If a country is represented by one or more registries but without national coverage, the registries are specified. National or subnational registries with cancer incidence data going back to at least 1998 were included and multiple datasets from subnational registries within a single country were combined, resulting in a total of 43 countries examined. To take advantage of the availability of 2 more contemporary incidence, we obtained additional data by contacting individual registries or accessing publicly available data online. We acquired data through 2015 from Australia ( www. aihw. gov. au/); through 2016 from Finland (personal communication), New Zealand (personal communication) and the USA (seer.cancer.gov/data/); and through 2017 from Norway (personal communication) and Sweden (sdb.socialstyrelsen.se/ if_can/val.aspx). Seven countries had fewer than 10 CRC cases among ages 20–49 years in any single diagnosis year and were excluded from trend analysis. Incidence was stratified by age at diagnosis, categorised as 20–49 years (‘early-onset’) or 50 years or older (‘older adults’). Cancer subsite was categorised according to the International Classification of Diseases, 10th revision as colon (code C18) or rectum (code C19-C20). Given that trends in CRC incidence are quite similar in men and women overall2 and for earlyonset disease,6 15 16 the two sexes were combined to improve stability. Primary outcome measures were average annual incidence rates during diagnosis years 2008–2012 (42 countries; data unavailable for Finland) and time-weighted average annual per cent change (AAPC) in incidence rates during the last 10 years of available data (36 countries) based on joinpoint regression analysis. This method fits joined straight lines (joinpoints) to observed annual age-standardised rates on a logarithmic scale.17 The maximum number of joinpoints is determined by the number of years available for each country/registry and was limited to four for countries with ≥24 data years. Trends are described as ‘increasing’ or ‘decreasing’ if the AAPC is statistically significantly different from zero (p<0.05) and ‘stable’ otherwise. All rates are expressed per 100 000 population and age-standardised to the 1960 Segi world standard population (as modified by Doll and Cook).18 In a sensitivity analysis, we assessed the extent to which the inclusion of appendiceal cancer (C18.1) in the CI5plus grouping for colon cancer influenced our results by calculating rates and trends exclusive of appendix for three countries for which these data were available (USA, New Zealand and Canada). Results CRC incidence during 2008–2012 Among 42 countries with high-quality population-based cancer registry data, cross-sectional age-standardised CRC incidence rates in ages 20–49 years during 2008–2012 were lowest in India (Chennai; 3.5 per 100 000 (95% CI 3.2 to 3.9)); Uganda (3.8, 95% CI 3.0 to 4.6); and Chile (3.8, 95% CI 2.5 to 5.1) and highest in Korea (12.9, 95% CI 12.6 to 13.3); Australia (11.2, 95% CI 10.9 to 11.5); the USA (10.0, 95% CI 9.8 to 10.3); and Slovakia (10.0, 95% CI 9.3 to 10.7; figure 1; online supplementary table 1). The pattern in older adults was quite similar, with rates ranging from 27.5 (95% CI 25.9 to 29.1) in India to 192.5 (95% CI 188.6 to 196.3) in Slovakia (online supplementary table 2). Among young adults, incidence was generally higher for tumours developing in the colon than in the rectum, with a more than twofold difference in rates in Iceland, Italy and Cyprus (online supplementary tables 3 and 4). Exceptions were in Slovenia, where rates were similar, and Korea, India and China, where rates were slightly higher for rectal cancer. In contrast, incidence rates in older adults were a minimum of 7% higher for colon cancer than for rectal cancer (India, 14.2 per 100 000 vs 13.3) and commonly twofold higher, particularly in high incidence countries (online supplementary tables 5 and 6). Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 2 Average annual per cent change (AAPC) in colorectal cancer incidence by age during the most recent 10 years of available data (A) countries with stable or declining trend among adults age 50 and older (B) countries with increasing trend among adults age 50 and older. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); Costa Rica (2002–2011); Finland (2007–2016); New Zealand (2007–2016); Norway (2008–2017); Slovakia (2001–2010); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. CRC incidence trends Among 36 countries with a sufficient number of annual cases, CRC incidence in adults <50 during the past 10 years was stable in 14 countries and decreased in three—Austria, Italy and Lithuania—all by about 1% annually (online supplementary table 1). Incidence in adults 50 and older likewise declined in Austria and Italy, as well as in nine additional countries (online supplementary table 2). The increasing CRC trend in adults <50 in the remaining 19 countries was unique to that age group in nine countries (figure 2A). Among these nine countries, rates in older adults declined by 1%–2.4% per year in Germany, Canada, New Zealand, Australia, and USA, and were stable in UK, Sweden, Denmark, and Slovenia. Where data were available prior to 1990, the uptick in early-onset CRC began during 1992–1996 and was preceded by declining rates except in Slovenia, where there was a continuous increase of 0.8% per year from 1983 to 2012 (figure 3; online supplementary table 1). Early-onset CRC incidence increased most rapidly in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)), where rates rose at a similar pace among adults 50 and older (figure 2B). Incidence increased in both younger and older age groups in about one-quarter of countries examined; among these, the magnitude of the AAPC for young adults was notably larger than that for older adults in Cyprus, Netherlands and Norway. In Norway, for example, the Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 AAPC was 1.9 (95% CI 1.4 to 2.5) among ages 20–49 versus 0.5 (95% CI 0.3 to 0.7) among ages 50 and older (figure 2B; online supplementary tables 1 and 2). In the Netherlands, the respective AAPCs were 2.0 (95% CI 1.6 to 2.4) versus 1.1 (95% CI 0.7 to 1.6), and the most recent linear (joinpoint) segment (2007–2012) was stable in older adults. Incidence in young adults began to increase in 1998 in Netherlands and 1996 in Norway according to joinpoint analysis, consistent with the timing of the trend in other high-income countries. Subsite-specific incidence trends Subsite-specific incidence trends varied with no clear pattern. For example, declines in early-onset CRC were confined to colon cancer in Italy and Lithuania, but to rectal cancer in Austria (online supplementary tables 3–4). In countries with increasing rates exclusively for early-onset disease, AAPCs were comparable for colon and rectal tumours in the USA, Sweden and Denmark; larger for, or confined to, colon tumours in Australia, New Zealand, Germany and UK; and larger for rectal tumours in Canada and Slovenia. Notably, rectal cancer incidence in the Netherlands increased among adults <50 years (AAPC, 1.9 (95% CI 1.4 to 2.5)) but not among older adults (AAPC, −0.1 (95% CI −0.8 to 0.7)). Importantly, the interpretation of 3 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 3 Colorectal cancer incidence trends by age, including the average annual per cent change (AAPC) during the most recent 10 years of available data, among countries with a unique increase in early-onset disease, by continent: (A) North America and Oceania (B) Europe. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); New Zealand (2007–2016); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. these subsite-specific differences is limited by the inclusion of appendiceal malignancies (C18.1) within the grouping for colon cancer (C18) in CI5 data. The AAPC for appendiceal cancer incidence in the USA during 2007–2016 was 15.5 (95% CI 11.5 to 19.7) in ages 20–49 years.19 We evaluated the extent to which the inclusion of appendiceal malignancies influenced our results 4 by calculating AAPCs for CRC and colon cancer in the absence of appendiceal cancer for three countries (USA, New Zealand and Canada) for which these data were available. In the USA, the AAPC during 2007–2016 in ages 20–49 years excluding appendix was 1.7 (95% CI 1.5 to 2.0) for CRC (vs 2.2 (95% CI 1.9 to 2.5) including appendix) and 1.3 (95% CI 1.0 to 1.7) for Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer colon cancer (vs 2.1 (95% CI 1.7 to 2.6) including appendix) (online supplementary table 7). Thus, the AAPC for colon cancer (excluding appendix) is substantially smaller than that for rectal cancer (2.1, 95% CI 1.7 to 2.5) whereas it previously appeared identical. Results were similar for New Zealand and Canada. Discussion We found that the geographic variation in CRC incidence among adults ages 20–49 mirrors that in older adults, with a threefold difference between the highest (12.9 per 100 000 in Korea) and lowest (3.5 per 100 000 in India) rates. In contrast, age-specific temporal trends were variable, with a decline limited to three countries (Austria, Italy and Lithuania) for young-onset CRC versus 11 for older adults. Conversely, increasing incidence was unique to young adults in nine high-income countries (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA) spanning three continents, often against a backdrop of rapidly declining rates in older adults. Similarly, increasing trends in Cyprus, Netherlands and Norway were twice as steep in young adults as in older adults. Our findings are consistent with previous, mostly country-level studies of age-related differences in temporal trends of CRC.5 7–9 11 The most rapid increases in early-onset CRC occurred in countries where rates are already highest, such as Korea, which had the same pattern for older adults. Reasons for the high and escalating burden in Korea are unclear, but may be related to the rapid dietary transition that took place in the wake of remarkable economic growth following the Korean war.20 Changes in the food supply were also initiated by the importation of wheat from the USA in response to food shortages in the late 1960s, which prompted the production of many wheat-derived processed foods during the 1970s. Shortly thereafter was the introduction of fast-food restaurants especially popular among youth. The obesity epidemic may also be a factor, given that East Asia has experienced among the largest relative increases in body mass index (BMI) worldwide among both adults and children.21 Asians have disproportionately high levels of visceral adiposity compared with Caucasians,22 23 which may more strongly influence CRC risk than BMI or waist circumference.24 25 Another potential contributor is the high prevalence of early-life antibiotic use, which has been associated with increased risk of colorectal adenoma, especially in the rectum.26 A recent study found that among six high-income countries, South Korea had the highest rate of paediatric antibiotic consumption, sevenfold higher than that in Norway, which had the lowest rate.27 The adenoma detection rate among Korean individuals in their 40s has been reported at almost 30%,28 three times higher than that in Australians.29 Early-onset CRC also increased rapidly in countries where risk in older adults is declining at a similar pace, such as New Zealand, Australia, Canada and the USA. Reductions in CRC incidence among older adults in some countries are partly attributed to changing patterns in risk factors, such as reductions in smoking and widespread use of anti-inflammatory drugs.2 30 Likewise, rising incidence confined to young age groups signals changes in early life exposures that adversely influence CRC risk, particularly given the strong birth cohort effect apparent in the trend.5 9 11 Notably, eight of the nine countries with a unique rise in early-onset CRC had declining rates prior to the uptick beginning in the mid-1990s. Reductions in the prevalence of protective factors, such as physical activity (for colon cancer) and sufficient intake of dietary fibre, dairy, and fruits and vegetables, may play a role, as well as increased prevalence of obesity, smoking, Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 red and/or process meat consumption, and/or excess alcohol consumption.31 Obesity was recently found to be associated with a 20% excess risk of early-onset CRC,32 and prevalence has risen most rapidly in young adults33 and in English-speaking high-income countries,34 consistent with early-onset CRC patterns. However, increases in BMI are quite similar across Europe, despite varying CRC trends. For example, BMI increased from 24 kg/m2 in 1975 to 27 in 2014 in men in Germany, where early-onset CRC increased, as well as in Austria, Croatia, Israel and Italy, where it did not.34 BMI increases in women were smaller but also comparable. In addition, there are puzzling variations in the CRC trend by subsite,5 11 as well as by race/ethnicity and state within the USA,35 36 that suggest a role for risk factors beyond obesity. For example, obesity and a sedentary lifestyle are more strongly associated with colon tumours,37–40 yet rectal tumours appear to be driving the increase based on our findings herein and those of other studies.5 9 11 35 If this is true, the rectal epithelium may be more exposed and/or susceptible to the carcinogenic mechanisms causing the increase in disease. CRC risk is intrinsically linked to diet and its influence on gut immune response and inflammation.41 The global food supply has changed substantially in recent decades42 and evolving research is exploring the carcinogenic potential of relatively new food components. For example, associations have been uncovered between CRC and moderate consumption of sugar-sweetened beverages,43 as well as high fructose corn syrup specifically in animal studies,44 both in the absence of obesity and metabolic syndrome. An inflammatory diet, characterised by high consumption of processed foods and high-glycaemic load carbohydrates, creates an environment conducive to colonic proliferation45 and appears to increase CRC risk.46 What remains uncertain is how these dietary elements might influence early-life gut health. Importantly, the association between CRC and currently established risk factors is based almost entirely on disease occurrence in older aged cohorts.47 CRC screening programmes have mostly emerged over the past two decades and likely contributed to the declines in incidence among older adults in 11 countries. Of the 36 countries in our trend analysis, only four (Costa Rica, Cyprus, India and Philippines) lack a screening programme according to a recent global overview.48 In most countries, screening for CRC (generally with a stool test) is recommended to begin between the ages of 50 and 60 years. Exceptions are Italy, where screening begins at age 44 years, and China, Japan and Austria, where it begins at age 40. Notably, two (Austria and Italy) of the three countries where early-onset CRC declined have screened individuals beginning in their fourth decade since the early 1980s.48 Moreover, the decreasing trend among young adults in both Austria and Italy was confined to ages 40–49 years, with rates in ages 20–39 years increasing by 3% per year in Austria (data not shown). Although some of the rapid increases in early-onset CRC are reminiscent of the Korean thyroid cancer ‘epidemic’ that resulted from widespread ultrasound screening,49 overdetection of early-onset CRC is unlikely because screening before age 50 is rare in most countries, and mortality rates have also begun to rise.12 50 After an extensive evidence review, the American Cancer Society recently lowered the recommended age to begin screening from 50 to 45 because disease risk in individuals under 50 has shifted substantially51 and Cancer Intervention and Surveillance Modeling Network modelling studies found a greater benefit to burden ratio for initiation at age 45 compared with 50.52–54 The US Preventive Services Task Force, the other US entity that issues cancer screening guidelines, is currently in 5 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer the process of conducting an evidence review and expected to issue an updated recommendation by 2020–2021. Our study is the first to provide a comprehensive global assessment of contemporary trends in early-onset CRC based on high-quality population-based cancer incidence information. However, the interpretation of subsite-specific differences in CI5 data is limited by the inclusion of appendiceal malignancies within the grouping for colon cancer. Accumulating evidence suggests that these tumours differ from those that develop in the colon in their biology and other characteristics.55 Inclusion of appendix attenuates comparisons of the burden for colon versus rectal cancer. Additionally, although appendiceal cancer accounts for only about 10% of cases in ages <50 years (data for USA, New Zealand and Canada), incidence rates are rising rapidly in high-income countries56 57 due to changes in classification and improved detection. This likely hindered our ability to detect the steeper rise for rectal than for colon cancer that has been reported by numerous studies of early-onset CRC trends excluding appendix,5 9 11 but less often by those including appendix.12 Similarly, results from our sensitivity analyses that excluded appendix found larger increases for rectal than for colon tumours in each of the three countries with these data available. Incidence trends may also be influenced by temporal improvements in the quality of data, case capture, and specificity of coding. Other study limitations include incomplete population coverage for long-term incidence data in many countries; lack of more contemporary data (eg, since 2012) for most countries; and the absence of high-quality cancer registry data for the majority of low-income and middle-income countries. In summary, CRC incidence rates uniquely increased in young adults over the past two decades in nine high-income countries spanning three continents, often in sharp contrast to rapid declines in older adults. These patterns potentially signal changes in early-age exposures conducive to large bowel carcinogenesis and highlight an urgent need for research to explore the potentially unique aetiology of young-onset CRC. Beyond awaiting scientific discovery, clinicians have an opportunity to help mitigate premature morbidity and mortality from CRC with active documentation of familial cancer history; timely follow-up of symptoms, regardless of patient age; and screening when appropriate. Acknowledgements The authors gratefully acknowledge all cancer registries and their staff for their hard work and diligence in collecting cancer information, without which this research could not have been done. Contributors Study concept and design: RS, AJ. Analysis and interpretation of the data: RS, LT, AJ, IS. Drafting the manuscript: RS, LAT. Critical revision of the manuscript for important intellectual content: all authors. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. References 1 Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394–424. 2 Arnold M, Sierra MS, Laversanne M, et al. 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I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material. What factor is contributing most to the increased rate of colorectal cancer in young adults? Original article Global patterns and trends in colorectal cancer incidence in young adults Rebecca L Siegel, 1 Lindsey A Torre,1 Isabelle Soerjomataram,2 Richard B Hayes,3 Freddie Bray,2 Thomas K Weber,4,5 Ahmedin Jemal1 ►► Additional material is published online only. To view please visit the journal online (http://dx.doi.o rg/10.1136/ gutjnl-2 019-319511). 1 Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA 2 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France 3 Department of Population Health, New York University School of Medicine, New York, New York, USA 4 Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA 5 Department of Surgical Oncology, Northwell Health Cancer Institute, Great Neck, New York, USA Correspondence to Ms Rebecca L Siegel, American Cancer Society, Atlanta, GA 30303, USA; rebecca.siegel@cancer.org Received 22 July 2019 Revised 16 August 2019 Accepted 21 August 2019 Abstract Objective Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking. Design We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA). Results During 2008–2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with longterm data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)). Conclusion CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis. Introduction © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. To cite: Siegel RL, Torre LA, Soerjomataram I, et al. Gut Epub ahead of print: [please include Day Month Year]. doi:10.1136/ gutjnl-2019-319511 Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, with an estimated 1.8 million new cases in 2018.1 Global patterns vary widely and are strongly linked to human development index level, reflecting the adoption of western lifestyles that accompany economic transition and elevate risk. In general, CRC incidence is rising in low-income and middle-income countries but beginning to stabilise or decline in high-income countries, especially those that have implemented screening.2 However, accumulating evidence from studies Significance of this study What is already known on this subject? ►► Colorectal cancer (CRC) incidence rates in young adults (aged <50 years) are increasing in several countries, despite declining rates in older adults. The extent to which this pattern is occurring on a global scale is unknown. What are the new findings? ►► CRC incidence rates are uniquely increasing in young adults in nine high-income countries (Germany, USA, Australia, Canada, New Zealand, UK, Denmark, Slovenia and Sweden) across North America, Europe and Oceania where rates in older adults are stable or declining. Conversely, CRC declined in young adults in only three countries (Italy, Austria and Lithuania) compared with 11 countries in adults 50 and older. How might it impact on clinical practice in the foreseeable future? ►► Improving awareness of the marked increases in young-onset CRC incidence could facilitate more diligent assessment of cancer family history by primary care clinicians, as well as follow-up of symptoms in young individuals, many of whom are diagnosed at a late stage. These findings also highlight the need for research on early-life exposures in relation to colorectal carcinogenesis. of cancer registry data indicates that favourable overall trends are masking an increase in young-onset CRC in the USA,3–6 Australia7 8 and Canada.9 Although the absolute risk of CRC in adults younger than 50 years is low relative to older adults, disease trends in young age groups are a key indicator of recent changes in risk factor exposures and often foreshadow the future cancer burden.10 In addition to country-specific analyses, there are recent reports on early-onset CRC occurrence in seven high-income countries,11 in Europe12 and in 11 ‘industrialised’ countries (data through 2007).13 However, a comprehensive examination of contemporary trends on a global scale is lacking. We analysed high-quality longterm population-based data on CRC occurrence by age at diagnosis for 43 countries covering six continents. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 1 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 1 Age-standardised incidence rate during 2008–2012 for colorectal cancer among adults ages 20–49 years. Bar shading indicates trend in incidence rates based on 10-year average annual per cent change; red: statistically significant increase; blue: statistically significant decrease; grey: stable or insufficient number of cases for trend analysis (‡). Rate for Finland unavailable.*Rate based on data during 2008-2010.†Excludes Nunavut, Quebec, and Yukon.‡Excluded from trend analysis due to insufficient number of annual cases.¶Rate based on data during 2008-2011. Methods We obtained high-quality population-based annual incidence data for colon and rectal cancer diagnosed through 2012 from the Cancer Incidence in Five Continents (CI5plus) database of the International Association of Cancer Registries and the International Agency for Research on Cancer (IARC).14 The CI5plus database is compiled from cancer registry data worldwide using a process that ensures comparable information that meets high quality standards established by IARC. Specifically, on submission the data coding is verified, the format is standardised, and an editorial board conducts an evaluation based on three dimensions of quality: comparability, completeness and validity. (For more information about the database, see c i5.iarc. fr/CI5-XI/Default.aspx.) The population coverage of registries included in CI5 may be national or subnational. If a country is represented by one or more registries but without national coverage, the registries are specified. National or subnational registries with cancer incidence data going back to at least 1998 were included and multiple datasets from subnational registries within a single country were combined, resulting in a total of 43 countries examined. To take advantage of the availability of 2 more contemporary incidence, we obtained additional data by contacting individual registries or accessing publicly available data online. We acquired data through 2015 from Australia ( www. aihw. gov. au/); through 2016 from Finland (personal communication), New Zealand (personal communication) and the USA (seer.cancer.gov/data/); and through 2017 from Norway (personal communication) and Sweden (sdb.socialstyrelsen.se/ if_can/val.aspx). Seven countries had fewer than 10 CRC cases among ages 20–49 years in any single diagnosis year and were excluded from trend analysis. Incidence was stratified by age at diagnosis, categorised as 20–49 years (‘early-onset’) or 50 years or older (‘older adults’). Cancer subsite was categorised according to the International Classification of Diseases, 10th revision as colon (code C18) or rectum (code C19-C20). Given that trends in CRC incidence are quite similar in men and women overall2 and for earlyonset disease,6 15 16 the two sexes were combined to improve stability. Primary outcome measures were average annual incidence rates during diagnosis years 2008–2012 (42 countries; data unavailable for Finland) and time-weighted average annual per cent change (AAPC) in incidence rates during the last 10 years of available data (36 countries) based on joinpoint regression analysis. This method fits joined straight lines (joinpoints) to observed annual age-standardised rates on a logarithmic scale.17 The maximum number of joinpoints is determined by the number of years available for each country/registry and was limited to four for countries with ≥24 data years. Trends are described as ‘increasing’ or ‘decreasing’ if the AAPC is statistically significantly different from zero (p<0.05) and ‘stable’ otherwise. All rates are expressed per 100 000 population and age-standardised to the 1960 Segi world standard population (as modified by Doll and Cook).18 In a sensitivity analysis, we assessed the extent to which the inclusion of appendiceal cancer (C18.1) in the CI5plus grouping for colon cancer influenced our results by calculating rates and trends exclusive of appendix for three countries for which these data were available (USA, New Zealand and Canada). Results CRC incidence during 2008–2012 Among 42 countries with high-quality population-based cancer registry data, cross-sectional age-standardised CRC incidence rates in ages 20–49 years during 2008–2012 were lowest in India (Chennai; 3.5 per 100 000 (95% CI 3.2 to 3.9)); Uganda (3.8, 95% CI 3.0 to 4.6); and Chile (3.8, 95% CI 2.5 to 5.1) and highest in Korea (12.9, 95% CI 12.6 to 13.3); Australia (11.2, 95% CI 10.9 to 11.5); the USA (10.0, 95% CI 9.8 to 10.3); and Slovakia (10.0, 95% CI 9.3 to 10.7; figure 1; online supplementary table 1). The pattern in older adults was quite similar, with rates ranging from 27.5 (95% CI 25.9 to 29.1) in India to 192.5 (95% CI 188.6 to 196.3) in Slovakia (online supplementary table 2). Among young adults, incidence was generally higher for tumours developing in the colon than in the rectum, with a more than twofold difference in rates in Iceland, Italy and Cyprus (online supplementary tables 3 and 4). Exceptions were in Slovenia, where rates were similar, and Korea, India and China, where rates were slightly higher for rectal cancer. In contrast, incidence rates in older adults were a minimum of 7% higher for colon cancer than for rectal cancer (India, 14.2 per 100 000 vs 13.3) and commonly twofold higher, particularly in high incidence countries (online supplementary tables 5 and 6). Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 2 Average annual per cent change (AAPC) in colorectal cancer incidence by age during the most recent 10 years of available data (A) countries with stable or declining trend among adults age 50 and older (B) countries with increasing trend among adults age 50 and older. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); Costa Rica (2002–2011); Finland (2007–2016); New Zealand (2007–2016); Norway (2008–2017); Slovakia (2001–2010); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. CRC incidence trends Among 36 countries with a sufficient number of annual cases, CRC incidence in adults <50 during the past 10 years was stable in 14 countries and decreased in three—Austria, Italy and Lithuania—all by about 1% annually (online supplementary table 1). Incidence in adults 50 and older likewise declined in Austria and Italy, as well as in nine additional countries (online supplementary table 2). The increasing CRC trend in adults <50 in the remaining 19 countries was unique to that age group in nine countries (figure 2A). Among these nine countries, rates in older adults declined by 1%–2.4% per year in Germany, Canada, New Zealand, Australia, and USA, and were stable in UK, Sweden, Denmark, and Slovenia. Where data were available prior to 1990, the uptick in early-onset CRC began during 1992–1996 and was preceded by declining rates except in Slovenia, where there was a continuous increase of 0.8% per year from 1983 to 2012 (figure 3; online supplementary table 1). Early-onset CRC incidence increased most rapidly in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)), where rates rose at a similar pace among adults 50 and older (figure 2B). Incidence increased in both younger and older age groups in about one-quarter of countries examined; among these, the magnitude of the AAPC for young adults was notably larger than that for older adults in Cyprus, Netherlands and Norway. In Norway, for example, the Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 AAPC was 1.9 (95% CI 1.4 to 2.5) among ages 20–49 versus 0.5 (95% CI 0.3 to 0.7) among ages 50 and older (figure 2B; online supplementary tables 1 and 2). In the Netherlands, the respective AAPCs were 2.0 (95% CI 1.6 to 2.4) versus 1.1 (95% CI 0.7 to 1.6), and the most recent linear (joinpoint) segment (2007–2012) was stable in older adults. Incidence in young adults began to increase in 1998 in Netherlands and 1996 in Norway according to joinpoint analysis, consistent with the timing of the trend in other high-income countries. Subsite-specific incidence trends Subsite-specific incidence trends varied with no clear pattern. For example, declines in early-onset CRC were confined to colon cancer in Italy and Lithuania, but to rectal cancer in Austria (online supplementary tables 3–4). In countries with increasing rates exclusively for early-onset disease, AAPCs were comparable for colon and rectal tumours in the USA, Sweden and Denmark; larger for, or confined to, colon tumours in Australia, New Zealand, Germany and UK; and larger for rectal tumours in Canada and Slovenia. Notably, rectal cancer incidence in the Netherlands increased among adults <50 years (AAPC, 1.9 (95% CI 1.4 to 2.5)) but not among older adults (AAPC, −0.1 (95% CI −0.8 to 0.7)). Importantly, the interpretation of 3 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 3 Colorectal cancer incidence trends by age, including the average annual per cent change (AAPC) during the most recent 10 years of available data, among countries with a unique increase in early-onset disease, by continent: (A) North America and Oceania (B) Europe. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); New Zealand (2007–2016); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. these subsite-specific differences is limited by the inclusion of appendiceal malignancies (C18.1) within the grouping for colon cancer (C18) in CI5 data. The AAPC for appendiceal cancer incidence in the USA during 2007–2016 was 15.5 (95% CI 11.5 to 19.7) in ages 20–49 years.19 We evaluated the extent to which the inclusion of appendiceal malignancies influenced our results 4 by calculating AAPCs for CRC and colon cancer in the absence of appendiceal cancer for three countries (USA, New Zealand and Canada) for which these data were available. In the USA, the AAPC during 2007–2016 in ages 20–49 years excluding appendix was 1.7 (95% CI 1.5 to 2.0) for CRC (vs 2.2 (95% CI 1.9 to 2.5) including appendix) and 1.3 (95% CI 1.0 to 1.7) for Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer colon cancer (vs 2.1 (95% CI 1.7 to 2.6) including appendix) (online supplementary table 7). Thus, the AAPC for colon cancer (excluding appendix) is substantially smaller than that for rectal cancer (2.1, 95% CI 1.7 to 2.5) whereas it previously appeared identical. Results were similar for New Zealand and Canada. Discussion We found that the geographic variation in CRC incidence among adults ages 20–49 mirrors that in older adults, with a threefold difference between the highest (12.9 per 100 000 in Korea) and lowest (3.5 per 100 000 in India) rates. In contrast, age-specific temporal trends were variable, with a decline limited to three countries (Austria, Italy and Lithuania) for young-onset CRC versus 11 for older adults. Conversely, increasing incidence was unique to young adults in nine high-income countries (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA) spanning three continents, often against a backdrop of rapidly declining rates in older adults. Similarly, increasing trends in Cyprus, Netherlands and Norway were twice as steep in young adults as in older adults. Our findings are consistent with previous, mostly country-level studies of age-related differences in temporal trends of CRC.5 7–9 11 The most rapid increases in early-onset CRC occurred in countries where rates are already highest, such as Korea, which had the same pattern for older adults. Reasons for the high and escalating burden in Korea are unclear, but may be related to the rapid dietary transition that took place in the wake of remarkable economic growth following the Korean war.20 Changes in the food supply were also initiated by the importation of wheat from the USA in response to food shortages in the late 1960s, which prompted the production of many wheat-derived processed foods during the 1970s. Shortly thereafter was the introduction of fast-food restaurants especially popular among youth. The obesity epidemic may also be a factor, given that East Asia has experienced among the largest relative increases in body mass index (BMI) worldwide among both adults and children.21 Asians have disproportionately high levels of visceral adiposity compared with Caucasians,22 23 which may more strongly influence CRC risk than BMI or waist circumference.24 25 Another potential contributor is the high prevalence of early-life antibiotic use, which has been associated with increased risk of colorectal adenoma, especially in the rectum.26 A recent study found that among six high-income countries, South Korea had the highest rate of paediatric antibiotic consumption, sevenfold higher than that in Norway, which had the lowest rate.27 The adenoma detection rate among Korean individuals in their 40s has been reported at almost 30%,28 three times higher than that in Australians.29 Early-onset CRC also increased rapidly in countries where risk in older adults is declining at a similar pace, such as New Zealand, Australia, Canada and the USA. Reductions in CRC incidence among older adults in some countries are partly attributed to changing patterns in risk factors, such as reductions in smoking and widespread use of anti-inflammatory drugs.2 30 Likewise, rising incidence confined to young age groups signals changes in early life exposures that adversely influence CRC risk, particularly given the strong birth cohort effect apparent in the trend.5 9 11 Notably, eight of the nine countries with a unique rise in early-onset CRC had declining rates prior to the uptick beginning in the mid-1990s. Reductions in the prevalence of protective factors, such as physical activity (for colon cancer) and sufficient intake of dietary fibre, dairy, and fruits and vegetables, may play a role, as well as increased prevalence of obesity, smoking, Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 red and/or process meat consumption, and/or excess alcohol consumption.31 Obesity was recently found to be associated with a 20% excess risk of early-onset CRC,32 and prevalence has risen most rapidly in young adults33 and in English-speaking high-income countries,34 consistent with early-onset CRC patterns. However, increases in BMI are quite similar across Europe, despite varying CRC trends. For example, BMI increased from 24 kg/m2 in 1975 to 27 in 2014 in men in Germany, where early-onset CRC increased, as well as in Austria, Croatia, Israel and Italy, where it did not.34 BMI increases in women were smaller but also comparable. In addition, there are puzzling variations in the CRC trend by subsite,5 11 as well as by race/ethnicity and state within the USA,35 36 that suggest a role for risk factors beyond obesity. For example, obesity and a sedentary lifestyle are more strongly associated with colon tumours,37–40 yet rectal tumours appear to be driving the increase based on our findings herein and those of other studies.5 9 11 35 If this is true, the rectal epithelium may be more exposed and/or susceptible to the carcinogenic mechanisms causing the increase in disease. CRC risk is intrinsically linked to diet and its influence on gut immune response and inflammation.41 The global food supply has changed substantially in recent decades42 and evolving research is exploring the carcinogenic potential of relatively new food components. For example, associations have been uncovered between CRC and moderate consumption of sugar-sweetened beverages,43 as well as high fructose corn syrup specifically in animal studies,44 both in the absence of obesity and metabolic syndrome. An inflammatory diet, characterised by high consumption of processed foods and high-glycaemic load carbohydrates, creates an environment conducive to colonic proliferation45 and appears to increase CRC risk.46 What remains uncertain is how these dietary elements might influence early-life gut health. Importantly, the association between CRC and currently established risk factors is based almost entirely on disease occurrence in older aged cohorts.47 CRC screening programmes have mostly emerged over the past two decades and likely contributed to the declines in incidence among older adults in 11 countries. Of the 36 countries in our trend analysis, only four (Costa Rica, Cyprus, India and Philippines) lack a screening programme according to a recent global overview.48 In most countries, screening for CRC (generally with a stool test) is recommended to begin between the ages of 50 and 60 years. Exceptions are Italy, where screening begins at age 44 years, and China, Japan and Austria, where it begins at age 40. Notably, two (Austria and Italy) of the three countries where early-onset CRC declined have screened individuals beginning in their fourth decade since the early 1980s.48 Moreover, the decreasing trend among young adults in both Austria and Italy was confined to ages 40–49 years, with rates in ages 20–39 years increasing by 3% per year in Austria (data not shown). Although some of the rapid increases in early-onset CRC are reminiscent of the Korean thyroid cancer ‘epidemic’ that resulted from widespread ultrasound screening,49 overdetection of early-onset CRC is unlikely because screening before age 50 is rare in most countries, and mortality rates have also begun to rise.12 50 After an extensive evidence review, the American Cancer Society recently lowered the recommended age to begin screening from 50 to 45 because disease risk in individuals under 50 has shifted substantially51 and Cancer Intervention and Surveillance Modeling Network modelling studies found a greater benefit to burden ratio for initiation at age 45 compared with 50.52–54 The US Preventive Services Task Force, the other US entity that issues cancer screening guidelines, is currently in 5 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer the process of conducting an evidence review and expected to issue an updated recommendation by 2020–2021. Our study is the first to provide a comprehensive global assessment of contemporary trends in early-onset CRC based on high-quality population-based cancer incidence information. However, the interpretation of subsite-specific differences in CI5 data is limited by the inclusion of appendiceal malignancies within the grouping for colon cancer. Accumulating evidence suggests that these tumours differ from those that develop in the colon in their biology and other characteristics.55 Inclusion of appendix attenuates comparisons of the burden for colon versus rectal cancer. Additionally, although appendiceal cancer accounts for only about 10% of cases in ages <50 years (data for USA, New Zealand and Canada), incidence rates are rising rapidly in high-income countries56 57 due to changes in classification and improved detection. This likely hindered our ability to detect the steeper rise for rectal than for colon cancer that has been reported by numerous studies of early-onset CRC trends excluding appendix,5 9 11 but less often by those including appendix.12 Similarly, results from our sensitivity analyses that excluded appendix found larger increases for rectal than for colon tumours in each of the three countries with these data available. Incidence trends may also be influenced by temporal improvements in the quality of data, case capture, and specificity of coding. Other study limitations include incomplete population coverage for long-term incidence data in many countries; lack of more contemporary data (eg, since 2012) for most countries; and the absence of high-quality cancer registry data for the majority of low-income and middle-income countries. In summary, CRC incidence rates uniquely increased in young adults over the past two decades in nine high-income countries spanning three continents, often in sharp contrast to rapid declines in older adults. These patterns potentially signal changes in early-age exposures conducive to large bowel carcinogenesis and highlight an urgent need for research to explore the potentially unique aetiology of young-onset CRC. Beyond awaiting scientific discovery, clinicians have an opportunity to help mitigate premature morbidity and mortality from CRC with active documentation of familial cancer history; timely follow-up of symptoms, regardless of patient age; and screening when appropriate. Acknowledgements The authors gratefully acknowledge all cancer registries and their staff for their hard work and diligence in collecting cancer information, without which this research could not have been done. Contributors Study concept and design: RS, AJ. Analysis and interpretation of the data: RS, LT, AJ, IS. Drafting the manuscript: RS, LAT. Critical revision of the manuscript for important intellectual content: all authors. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. References 1 Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394–424. 2 Arnold M, Sierra MS, Laversanne M, et al. 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The rise in appendiceal cancer incidence: 2000-2009. J Gastrointest Surg 2015;19:743–50. 57 van den Heuvel MGW, Lemmens VEPP, Verhoeven RHA, et al. The incidence of mucinous appendiceal malignancies: a population-based study. Int J Colorectal Dis 2013;28:1307–10. 7 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer
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Original article Global patterns and trends in colorectal cancer incidence in young adults Rebecca L Siegel, 1 Lindsey A Torre,1 Isabelle Soerjomataram,2 Richard B Hayes,3 Freddie Bray,2 Thomas K Weber,4,5 Ahmedin Jemal1 ►► Additional material is published online only. To view please visit the journal online (http://dx.doi.o rg/10.1136/ gutjnl-2 019-319511). 1 Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA 2 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France 3 Department of Population Health, New York University School of Medicine, New York, New York, USA 4 Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA 5 Department of Surgical Oncology, Northwell Health Cancer Institute, Great Neck, New York, USA Correspondence to Ms Rebecca L Siegel, American Cancer Society, Atlanta, GA 30303, USA; rebecca.siegel@cancer.org Received 22 July 2019 Revised 16 August 2019 Accepted 21 August 2019 Abstract Objective Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking. Design We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA). Results During 2008–2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with longterm data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)). Conclusion CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis. Introduction © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. To cite: Siegel RL, Torre LA, Soerjomataram I, et al. Gut Epub ahead of print: [please include Day Month Year]. doi:10.1136/ gutjnl-2019-319511 Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, with an estimated 1.8 million new cases in 2018.1 Global patterns vary widely and are strongly linked to human development index level, reflecting the adoption of western lifestyles that accompany economic transition and elevate risk. In general, CRC incidence is rising in low-income and middle-income countries but beginning to stabilise or decline in high-income countries, especially those that have implemented screening.2 However, accumulating evidence from studies Significance of this study What is already known on this subject? ►► Colorectal cancer (CRC) incidence rates in young adults (aged <50 years) are increasing in several countries, despite declining rates in older adults. The extent to which this pattern is occurring on a global scale is unknown. What are the new findings? ►► CRC incidence rates are uniquely increasing in young adults in nine high-income countries (Germany, USA, Australia, Canada, New Zealand, UK, Denmark, Slovenia and Sweden) across North America, Europe and Oceania where rates in older adults are stable or declining. Conversely, CRC declined in young adults in only three countries (Italy, Austria and Lithuania) compared with 11 countries in adults 50 and older. How might it impact on clinical practice in the foreseeable future? ►► Improving awareness of the marked increases in young-onset CRC incidence could facilitate more diligent assessment of cancer family history by primary care clinicians, as well as follow-up of symptoms in young individuals, many of whom are diagnosed at a late stage. These findings also highlight the need for research on early-life exposures in relation to colorectal carcinogenesis. of cancer registry data indicates that favourable overall trends are masking an increase in young-onset CRC in the USA,3–6 Australia7 8 and Canada.9 Although the absolute risk of CRC in adults younger than 50 years is low relative to older adults, disease trends in young age groups are a key indicator of recent changes in risk factor exposures and often foreshadow the future cancer burden.10 In addition to country-specific analyses, there are recent reports on early-onset CRC occurrence in seven high-income countries,11 in Europe12 and in 11 ‘industrialised’ countries (data through 2007).13 However, a comprehensive examination of contemporary trends on a global scale is lacking. We analysed high-quality longterm population-based data on CRC occurrence by age at diagnosis for 43 countries covering six continents. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 1 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 1 Age-standardised incidence rate during 2008–2012 for colorectal cancer among adults ages 20–49 years. Bar shading indicates trend in incidence rates based on 10-year average annual per cent change; red: statistically significant increase; blue: statistically significant decrease; grey: stable or insufficient number of cases for trend analysis (‡). Rate for Finland unavailable.*Rate based on data during 2008-2010.†Excludes Nunavut, Quebec, and Yukon.‡Excluded from trend analysis due to insufficient number of annual cases.¶Rate based on data during 2008-2011. Methods We obtained high-quality population-based annual incidence data for colon and rectal cancer diagnosed through 2012 from the Cancer Incidence in Five Continents (CI5plus) database of the International Association of Cancer Registries and the International Agency for Research on Cancer (IARC).14 The CI5plus database is compiled from cancer registry data worldwide using a process that ensures comparable information that meets high quality standards established by IARC. Specifically, on submission the data coding is verified, the format is standardised, and an editorial board conducts an evaluation based on three dimensions of quality: comparability, completeness and validity. (For more information about the database, see c i5.iarc. fr/CI5-XI/Default.aspx.) The population coverage of registries included in CI5 may be national or subnational. If a country is represented by one or more registries but without national coverage, the registries are specified. National or subnational registries with cancer incidence data going back to at least 1998 were included and multiple datasets from subnational registries within a single country were combined, resulting in a total of 43 countries examined. To take advantage of the availability of 2 more contemporary incidence, we obtained additional data by contacting individual registries or accessing publicly available data online. We acquired data through 2015 from Australia ( www. aihw. gov. au/); through 2016 from Finland (personal communication), New Zealand (personal communication) and the USA (seer.cancer.gov/data/); and through 2017 from Norway (personal communication) and Sweden (sdb.socialstyrelsen.se/ if_can/val.aspx). Seven countries had fewer than 10 CRC cases among ages 20–49 years in any single diagnosis year and were excluded from trend analysis. Incidence was stratified by age at diagnosis, categorised as 20–49 years (‘early-onset’) or 50 years or older (‘older adults’). Cancer subsite was categorised according to the International Classification of Diseases, 10th revision as colon (code C18) or rectum (code C19-C20). Given that trends in CRC incidence are quite similar in men and women overall2 and for earlyonset disease,6 15 16 the two sexes were combined to improve stability. Primary outcome measures were average annual incidence rates during diagnosis years 2008–2012 (42 countries; data unavailable for Finland) and time-weighted average annual per cent change (AAPC) in incidence rates during the last 10 years of available data (36 countries) based on joinpoint regression analysis. This method fits joined straight lines (joinpoints) to observed annual age-standardised rates on a logarithmic scale.17 The maximum number of joinpoints is determined by the number of years available for each country/registry and was limited to four for countries with ≥24 data years. Trends are described as ‘increasing’ or ‘decreasing’ if the AAPC is statistically significantly different from zero (p<0.05) and ‘stable’ otherwise. All rates are expressed per 100 000 population and age-standardised to the 1960 Segi world standard population (as modified by Doll and Cook).18 In a sensitivity analysis, we assessed the extent to which the inclusion of appendiceal cancer (C18.1) in the CI5plus grouping for colon cancer influenced our results by calculating rates and trends exclusive of appendix for three countries for which these data were available (USA, New Zealand and Canada). Results CRC incidence during 2008–2012 Among 42 countries with high-quality population-based cancer registry data, cross-sectional age-standardised CRC incidence rates in ages 20–49 years during 2008–2012 were lowest in India (Chennai; 3.5 per 100 000 (95% CI 3.2 to 3.9)); Uganda (3.8, 95% CI 3.0 to 4.6); and Chile (3.8, 95% CI 2.5 to 5.1) and highest in Korea (12.9, 95% CI 12.6 to 13.3); Australia (11.2, 95% CI 10.9 to 11.5); the USA (10.0, 95% CI 9.8 to 10.3); and Slovakia (10.0, 95% CI 9.3 to 10.7; figure 1; online supplementary table 1). The pattern in older adults was quite similar, with rates ranging from 27.5 (95% CI 25.9 to 29.1) in India to 192.5 (95% CI 188.6 to 196.3) in Slovakia (online supplementary table 2). Among young adults, incidence was generally higher for tumours developing in the colon than in the rectum, with a more than twofold difference in rates in Iceland, Italy and Cyprus (online supplementary tables 3 and 4). Exceptions were in Slovenia, where rates were similar, and Korea, India and China, where rates were slightly higher for rectal cancer. In contrast, incidence rates in older adults were a minimum of 7% higher for colon cancer than for rectal cancer (India, 14.2 per 100 000 vs 13.3) and commonly twofold higher, particularly in high incidence countries (online supplementary tables 5 and 6). Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 2 Average annual per cent change (AAPC) in colorectal cancer incidence by age during the most recent 10 years of available data (A) countries with stable or declining trend among adults age 50 and older (B) countries with increasing trend among adults age 50 and older. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); Costa Rica (2002–2011); Finland (2007–2016); New Zealand (2007–2016); Norway (2008–2017); Slovakia (2001–2010); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. CRC incidence trends Among 36 countries with a sufficient number of annual cases, CRC incidence in adults <50 during the past 10 years was stable in 14 countries and decreased in three—Austria, Italy and Lithuania—all by about 1% annually (online supplementary table 1). Incidence in adults 50 and older likewise declined in Austria and Italy, as well as in nine additional countries (online supplementary table 2). The increasing CRC trend in adults <50 in the remaining 19 countries was unique to that age group in nine countries (figure 2A). Among these nine countries, rates in older adults declined by 1%–2.4% per year in Germany, Canada, New Zealand, Australia, and USA, and were stable in UK, Sweden, Denmark, and Slovenia. Where data were available prior to 1990, the uptick in early-onset CRC began during 1992–1996 and was preceded by declining rates except in Slovenia, where there was a continuous increase of 0.8% per year from 1983 to 2012 (figure 3; online supplementary table 1). Early-onset CRC incidence increased most rapidly in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)), where rates rose at a similar pace among adults 50 and older (figure 2B). Incidence increased in both younger and older age groups in about one-quarter of countries examined; among these, the magnitude of the AAPC for young adults was notably larger than that for older adults in Cyprus, Netherlands and Norway. In Norway, for example, the Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 AAPC was 1.9 (95% CI 1.4 to 2.5) among ages 20–49 versus 0.5 (95% CI 0.3 to 0.7) among ages 50 and older (figure 2B; online supplementary tables 1 and 2). In the Netherlands, the respective AAPCs were 2.0 (95% CI 1.6 to 2.4) versus 1.1 (95% CI 0.7 to 1.6), and the most recent linear (joinpoint) segment (2007–2012) was stable in older adults. Incidence in young adults began to increase in 1998 in Netherlands and 1996 in Norway according to joinpoint analysis, consistent with the timing of the trend in other high-income countries. Subsite-specific incidence trends Subsite-specific incidence trends varied with no clear pattern. For example, declines in early-onset CRC were confined to colon cancer in Italy and Lithuania, but to rectal cancer in Austria (online supplementary tables 3–4). In countries with increasing rates exclusively for early-onset disease, AAPCs were comparable for colon and rectal tumours in the USA, Sweden and Denmark; larger for, or confined to, colon tumours in Australia, New Zealand, Germany and UK; and larger for rectal tumours in Canada and Slovenia. Notably, rectal cancer incidence in the Netherlands increased among adults <50 years (AAPC, 1.9 (95% CI 1.4 to 2.5)) but not among older adults (AAPC, −0.1 (95% CI −0.8 to 0.7)). Importantly, the interpretation of 3 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 3 Colorectal cancer incidence trends by age, including the average annual per cent change (AAPC) during the most recent 10 years of available data, among countries with a unique increase in early-onset disease, by continent: (A) North America and Oceania (B) Europe. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); New Zealand (2007–2016); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. these subsite-specific differences is limited by the inclusion of appendiceal malignancies (C18.1) within the grouping for colon cancer (C18) in CI5 data. The AAPC for appendiceal cancer incidence in the USA during 2007–2016 was 15.5 (95% CI 11.5 to 19.7) in ages 20–49 years.19 We evaluated the extent to which the inclusion of appendiceal malignancies influenced our results 4 by calculating AAPCs for CRC and colon cancer in the absence of appendiceal cancer for three countries (USA, New Zealand and Canada) for which these data were available. In the USA, the AAPC during 2007–2016 in ages 20–49 years excluding appendix was 1.7 (95% CI 1.5 to 2.0) for CRC (vs 2.2 (95% CI 1.9 to 2.5) including appendix) and 1.3 (95% CI 1.0 to 1.7) for Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer colon cancer (vs 2.1 (95% CI 1.7 to 2.6) including appendix) (online supplementary table 7). Thus, the AAPC for colon cancer (excluding appendix) is substantially smaller than that for rectal cancer (2.1, 95% CI 1.7 to 2.5) whereas it previously appeared identical. Results were similar for New Zealand and Canada. Discussion We found that the geographic variation in CRC incidence among adults ages 20–49 mirrors that in older adults, with a threefold difference between the highest (12.9 per 100 000 in Korea) and lowest (3.5 per 100 000 in India) rates. In contrast, age-specific temporal trends were variable, with a decline limited to three countries (Austria, Italy and Lithuania) for young-onset CRC versus 11 for older adults. Conversely, increasing incidence was unique to young adults in nine high-income countries (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA) spanning three continents, often against a backdrop of rapidly declining rates in older adults. Similarly, increasing trends in Cyprus, Netherlands and Norway were twice as steep in young adults as in older adults. Our findings are consistent with previous, mostly country-level studies of age-related differences in temporal trends of CRC.5 7–9 11 The most rapid increases in early-onset CRC occurred in countries where rates are already highest, such as Korea, which had the same pattern for older adults. Reasons for the high and escalating burden in Korea are unclear, but may be related to the rapid dietary transition that took place in the wake of remarkable economic growth following the Korean war.20 Changes in the food supply were also initiated by the importation of wheat from the USA in response to food shortages in the late 1960s, which prompted the production of many wheat-derived processed foods during the 1970s. Shortly thereafter was the introduction of fast-food restaurants especially popular among youth. The obesity epidemic may also be a factor, given that East Asia has experienced among the largest relative increases in body mass index (BMI) worldwide among both adults and children.21 Asians have disproportionately high levels of visceral adiposity compared with Caucasians,22 23 which may more strongly influence CRC risk than BMI or waist circumference.24 25 Another potential contributor is the high prevalence of early-life antibiotic use, which has been associated with increased risk of colorectal adenoma, especially in the rectum.26 A recent study found that among six high-income countries, South Korea had the highest rate of paediatric antibiotic consumption, sevenfold higher than that in Norway, which had the lowest rate.27 The adenoma detection rate among Korean individuals in their 40s has been reported at almost 30%,28 three times higher than that in Australians.29 Early-onset CRC also increased rapidly in countries where risk in older adults is declining at a similar pace, such as New Zealand, Australia, Canada and the USA. Reductions in CRC incidence among older adults in some countries are partly attributed to changing patterns in risk factors, such as reductions in smoking and widespread use of anti-inflammatory drugs.2 30 Likewise, rising incidence confined to young age groups signals changes in early life exposures that adversely influence CRC risk, particularly given the strong birth cohort effect apparent in the trend.5 9 11 Notably, eight of the nine countries with a unique rise in early-onset CRC had declining rates prior to the uptick beginning in the mid-1990s. Reductions in the prevalence of protective factors, such as physical activity (for colon cancer) and sufficient intake of dietary fibre, dairy, and fruits and vegetables, may play a role, as well as increased prevalence of obesity, smoking, Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 red and/or process meat consumption, and/or excess alcohol consumption.31 Obesity was recently found to be associated with a 20% excess risk of early-onset CRC,32 and prevalence has risen most rapidly in young adults33 and in English-speaking high-income countries,34 consistent with early-onset CRC patterns. However, increases in BMI are quite similar across Europe, despite varying CRC trends. For example, BMI increased from 24 kg/m2 in 1975 to 27 in 2014 in men in Germany, where early-onset CRC increased, as well as in Austria, Croatia, Israel and Italy, where it did not.34 BMI increases in women were smaller but also comparable. In addition, there are puzzling variations in the CRC trend by subsite,5 11 as well as by race/ethnicity and state within the USA,35 36 that suggest a role for risk factors beyond obesity. For example, obesity and a sedentary lifestyle are more strongly associated with colon tumours,37–40 yet rectal tumours appear to be driving the increase based on our findings herein and those of other studies.5 9 11 35 If this is true, the rectal epithelium may be more exposed and/or susceptible to the carcinogenic mechanisms causing the increase in disease. CRC risk is intrinsically linked to diet and its influence on gut immune response and inflammation.41 The global food supply has changed substantially in recent decades42 and evolving research is exploring the carcinogenic potential of relatively new food components. For example, associations have been uncovered between CRC and moderate consumption of sugar-sweetened beverages,43 as well as high fructose corn syrup specifically in animal studies,44 both in the absence of obesity and metabolic syndrome. An inflammatory diet, characterised by high consumption of processed foods and high-glycaemic load carbohydrates, creates an environment conducive to colonic proliferation45 and appears to increase CRC risk.46 What remains uncertain is how these dietary elements might influence early-life gut health. Importantly, the association between CRC and currently established risk factors is based almost entirely on disease occurrence in older aged cohorts.47 CRC screening programmes have mostly emerged over the past two decades and likely contributed to the declines in incidence among older adults in 11 countries. Of the 36 countries in our trend analysis, only four (Costa Rica, Cyprus, India and Philippines) lack a screening programme according to a recent global overview.48 In most countries, screening for CRC (generally with a stool test) is recommended to begin between the ages of 50 and 60 years. Exceptions are Italy, where screening begins at age 44 years, and China, Japan and Austria, where it begins at age 40. Notably, two (Austria and Italy) of the three countries where early-onset CRC declined have screened individuals beginning in their fourth decade since the early 1980s.48 Moreover, the decreasing trend among young adults in both Austria and Italy was confined to ages 40–49 years, with rates in ages 20–39 years increasing by 3% per year in Austria (data not shown). Although some of the rapid increases in early-onset CRC are reminiscent of the Korean thyroid cancer ‘epidemic’ that resulted from widespread ultrasound screening,49 overdetection of early-onset CRC is unlikely because screening before age 50 is rare in most countries, and mortality rates have also begun to rise.12 50 After an extensive evidence review, the American Cancer Society recently lowered the recommended age to begin screening from 50 to 45 because disease risk in individuals under 50 has shifted substantially51 and Cancer Intervention and Surveillance Modeling Network modelling studies found a greater benefit to burden ratio for initiation at age 45 compared with 50.52–54 The US Preventive Services Task Force, the other US entity that issues cancer screening guidelines, is currently in 5 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer the process of conducting an evidence review and expected to issue an updated recommendation by 2020–2021. Our study is the first to provide a comprehensive global assessment of contemporary trends in early-onset CRC based on high-quality population-based cancer incidence information. However, the interpretation of subsite-specific differences in CI5 data is limited by the inclusion of appendiceal malignancies within the grouping for colon cancer. Accumulating evidence suggests that these tumours differ from those that develop in the colon in their biology and other characteristics.55 Inclusion of appendix attenuates comparisons of the burden for colon versus rectal cancer. Additionally, although appendiceal cancer accounts for only about 10% of cases in ages <50 years (data for USA, New Zealand and Canada), incidence rates are rising rapidly in high-income countries56 57 due to changes in classification and improved detection. This likely hindered our ability to detect the steeper rise for rectal than for colon cancer that has been reported by numerous studies of early-onset CRC trends excluding appendix,5 9 11 but less often by those including appendix.12 Similarly, results from our sensitivity analyses that excluded appendix found larger increases for rectal than for colon tumours in each of the three countries with these data available. Incidence trends may also be influenced by temporal improvements in the quality of data, case capture, and specificity of coding. Other study limitations include incomplete population coverage for long-term incidence data in many countries; lack of more contemporary data (eg, since 2012) for most countries; and the absence of high-quality cancer registry data for the majority of low-income and middle-income countries. In summary, CRC incidence rates uniquely increased in young adults over the past two decades in nine high-income countries spanning three continents, often in sharp contrast to rapid declines in older adults. These patterns potentially signal changes in early-age exposures conducive to large bowel carcinogenesis and highlight an urgent need for research to explore the potentially unique aetiology of young-onset CRC. Beyond awaiting scientific discovery, clinicians have an opportunity to help mitigate premature morbidity and mortality from CRC with active documentation of familial cancer history; timely follow-up of symptoms, regardless of patient age; and screening when appropriate. Acknowledgements The authors gratefully acknowledge all cancer registries and their staff for their hard work and diligence in collecting cancer information, without which this research could not have been done. Contributors Study concept and design: RS, AJ. Analysis and interpretation of the data: RS, LT, AJ, IS. Drafting the manuscript: RS, LAT. Critical revision of the manuscript for important intellectual content: all authors. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. References 1 Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394–424. 2 Arnold M, Sierra MS, Laversanne M, et al. 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The rise in appendiceal cancer incidence: 2000-2009. J Gastrointest Surg 2015;19:743–50. 57 van den Heuvel MGW, Lemmens VEPP, Verhoeven RHA, et al. The incidence of mucinous appendiceal malignancies: a population-based study. Int J Colorectal Dis 2013;28:1307–10. 7 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer
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What factor is contributing most to the increased rate of colorectal cancer in young adults?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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According to this article, what are the reasons that Plantir is growing its getting more commercial clients? Please tell me in easy to understand terms, I'm not an expert at this stuff.
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Palantir reported its Q2 FY24 earnings, where total revenue grew 27% YoY to $678M beating estimates. Out of the $678M in revenue, Government revenue accounted for roughly 55% of Total Revenue, growing 23% YoY. But the main hero of this growth story is its Commercial segment which is growing at a faster rate of 33% YoY and accounting for a growing share of Total Revenue when we compare it to the prior year. Particularly, when it comes to the Commercial revenue segment, its US market saw a growth rate of 55% YoY to $159M. While it saw a slowdown in its growth pace on a sequential basis to 6%, its annual growth rate indicates a reacceleration in trend, boosting investor optimism. This was driven by persistent demand for their enterprise platform, AIP (Artificial Intelligence Platform), that makes artificial capabilities useful to large organizations, providing them with a structural advantage over their competitors. What is even more impressive is that over 4 years ago, Palantir had just 14 commercial customers in the US. With the launch of AIP over a year ago, its US commercial customer count stands at 295, growing 83% YoY, as it captures the enterprise AI opportunity as the management claims that they solve the “prototype to production” problem like no other company. In Q2, the company closed 96 Commercial deals with at least $1M of TCV (Total Contract Value), which grew 45% YoY and 10% QoQ. However, with a closer look at this data point, we can see that the company saw a sequential acceleration in its $5M and $10M deals, which grew 22% and 80% QoQ to 33 and 27 respectively. This is driven by a combination of a higher volume of existing customers signing expansion deals with deepening product-level relationships as well as new customer acquisition where they leverage their go-to-market motion of bootcamps and pilots to accelerate customer journey towards high-value production use cases, with TCV growing 152% YoY in the US Commercial segment. At the same time, Palantir and Microsoft (MSFT) also announced a significant advancement in their partnership in August, where Palantir will deploy their suite of products in Microsoft Azure Government and in the Azure Government Secret and Top Secret Clouds, enabling operators to safely and responsibly build AI-driven operational workloads across Defense and Intelligence verticals for the US government. This should further drive deeper adoption of AIP in the federal sector, thus boosting the top line. Shifting gears to profitability, Palantir generated $254M in Adjusted Operating income, which grew 88% YoY with a margin expansion of 1200 basis points to 37%. Simultaneously, the company also achieved GAAP operating profitability for the sixth consecutive quarter with a GAAP operating margin of 16%, up 1400 basis points YoY. It is incredible that operating expenses just grew just 6% YoY for the magnitude of revenue growth. In other words, it saw its revenue growth accelerate while expanding margins at the same time, unlocking the “holy grail” in the world of SaaS with a Rule of 40 score from 57 in Q1 to 64 in Q2. I believe that this is made possible by its go-to-market strategy, which focuses on AIP Bootcamps and AIPCon that leverages the strength of its product to unlock potential client AI use cases instead of hoarding large numbers of salespeople. So far, with this strategy, it is seeing a steady increase in the number of clients along with existing clients expanding their usage of the platform, with the 12-month revenue from Top 20 customers growing 9% YoY to $57M/customer, thus enabling it to unlock operating leverage.
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== According to this article, what are the reasons that Plantir is growing its getting more commercial clients? Please tell me in easy to understand terms, I'm not an expert at this stuff. {passage 0} ========== Palantir reported its Q2 FY24 earnings, where total revenue grew 27% YoY to $678M beating estimates. Out of the $678M in revenue, Government revenue accounted for roughly 55% of Total Revenue, growing 23% YoY. But the main hero of this growth story is its Commercial segment which is growing at a faster rate of 33% YoY and accounting for a growing share of Total Revenue when we compare it to the prior year. Particularly, when it comes to the Commercial revenue segment, its US market saw a growth rate of 55% YoY to $159M. While it saw a slowdown in its growth pace on a sequential basis to 6%, its annual growth rate indicates a reacceleration in trend, boosting investor optimism. This was driven by persistent demand for their enterprise platform, AIP (Artificial Intelligence Platform), that makes artificial capabilities useful to large organizations, providing them with a structural advantage over their competitors. What is even more impressive is that over 4 years ago, Palantir had just 14 commercial customers in the US. With the launch of AIP over a year ago, its US commercial customer count stands at 295, growing 83% YoY, as it captures the enterprise AI opportunity as the management claims that they solve the “prototype to production” problem like no other company. In Q2, the company closed 96 Commercial deals with at least $1M of TCV (Total Contract Value), which grew 45% YoY and 10% QoQ. However, with a closer look at this data point, we can see that the company saw a sequential acceleration in its $5M and $10M deals, which grew 22% and 80% QoQ to 33 and 27 respectively. This is driven by a combination of a higher volume of existing customers signing expansion deals with deepening product-level relationships as well as new customer acquisition where they leverage their go-to-market motion of bootcamps and pilots to accelerate customer journey towards high-value production use cases, with TCV growing 152% YoY in the US Commercial segment. At the same time, Palantir and Microsoft (MSFT) also announced a significant advancement in their partnership in August, where Palantir will deploy their suite of products in Microsoft Azure Government and in the Azure Government Secret and Top Secret Clouds, enabling operators to safely and responsibly build AI-driven operational workloads across Defense and Intelligence verticals for the US government. This should further drive deeper adoption of AIP in the federal sector, thus boosting the top line. Shifting gears to profitability, Palantir generated $254M in Adjusted Operating income, which grew 88% YoY with a margin expansion of 1200 basis points to 37%. Simultaneously, the company also achieved GAAP operating profitability for the sixth consecutive quarter with a GAAP operating margin of 16%, up 1400 basis points YoY. It is incredible that operating expenses just grew just 6% YoY for the magnitude of revenue growth. In other words, it saw its revenue growth accelerate while expanding margins at the same time, unlocking the “holy grail” in the world of SaaS with a Rule of 40 score from 57 in Q1 to 64 in Q2. I believe that this is made possible by its go-to-market strategy, which focuses on AIP Bootcamps and AIPCon that leverages the strength of its product to unlock potential client AI use cases instead of hoarding large numbers of salespeople. So far, with this strategy, it is seeing a steady increase in the number of clients along with existing clients expanding their usage of the platform, with the 12-month revenue from Top 20 customers growing 9% YoY to $57M/customer, thus enabling it to unlock operating leverage. https://seekingalpha.com/article/4720671-palantir-80x-pe-pure-nosebleed#source=first_level_url%3Ahome%7Csection%3Atrending_articles%7Crecommendation_type%3Adefault%7Cline%3A11
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
Palantir reported its Q2 FY24 earnings, where total revenue grew 27% YoY to $678M beating estimates. Out of the $678M in revenue, Government revenue accounted for roughly 55% of Total Revenue, growing 23% YoY. But the main hero of this growth story is its Commercial segment which is growing at a faster rate of 33% YoY and accounting for a growing share of Total Revenue when we compare it to the prior year. Particularly, when it comes to the Commercial revenue segment, its US market saw a growth rate of 55% YoY to $159M. While it saw a slowdown in its growth pace on a sequential basis to 6%, its annual growth rate indicates a reacceleration in trend, boosting investor optimism. This was driven by persistent demand for their enterprise platform, AIP (Artificial Intelligence Platform), that makes artificial capabilities useful to large organizations, providing them with a structural advantage over their competitors. What is even more impressive is that over 4 years ago, Palantir had just 14 commercial customers in the US. With the launch of AIP over a year ago, its US commercial customer count stands at 295, growing 83% YoY, as it captures the enterprise AI opportunity as the management claims that they solve the “prototype to production” problem like no other company. In Q2, the company closed 96 Commercial deals with at least $1M of TCV (Total Contract Value), which grew 45% YoY and 10% QoQ. However, with a closer look at this data point, we can see that the company saw a sequential acceleration in its $5M and $10M deals, which grew 22% and 80% QoQ to 33 and 27 respectively. This is driven by a combination of a higher volume of existing customers signing expansion deals with deepening product-level relationships as well as new customer acquisition where they leverage their go-to-market motion of bootcamps and pilots to accelerate customer journey towards high-value production use cases, with TCV growing 152% YoY in the US Commercial segment. At the same time, Palantir and Microsoft (MSFT) also announced a significant advancement in their partnership in August, where Palantir will deploy their suite of products in Microsoft Azure Government and in the Azure Government Secret and Top Secret Clouds, enabling operators to safely and responsibly build AI-driven operational workloads across Defense and Intelligence verticals for the US government. This should further drive deeper adoption of AIP in the federal sector, thus boosting the top line. Shifting gears to profitability, Palantir generated $254M in Adjusted Operating income, which grew 88% YoY with a margin expansion of 1200 basis points to 37%. Simultaneously, the company also achieved GAAP operating profitability for the sixth consecutive quarter with a GAAP operating margin of 16%, up 1400 basis points YoY. It is incredible that operating expenses just grew just 6% YoY for the magnitude of revenue growth. In other words, it saw its revenue growth accelerate while expanding margins at the same time, unlocking the “holy grail” in the world of SaaS with a Rule of 40 score from 57 in Q1 to 64 in Q2. I believe that this is made possible by its go-to-market strategy, which focuses on AIP Bootcamps and AIPCon that leverages the strength of its product to unlock potential client AI use cases instead of hoarding large numbers of salespeople. So far, with this strategy, it is seeing a steady increase in the number of clients along with existing clients expanding their usage of the platform, with the 12-month revenue from Top 20 customers growing 9% YoY to $57M/customer, thus enabling it to unlock operating leverage.
USER:
According to this article, what are the reasons that Plantir is growing its getting more commercial clients? Please tell me in easy to understand terms, I'm not an expert at this stuff.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 32 | 597 | null | 804 |
You base all answers on the provided context block. Use only the information in the context block to answer the user's question.
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How do the two parts of the nest interface?
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Abstract The Nest Thermostat is a smart home automation device that aims to learn a user’s heating and cooling habits to help optimize scheduling and power usage. With its debut in 2011, Nest has proven to be such a success that Google spent $3.2B to acquire the company. However, the complexity of the infrastructure in the Nest Thermostat provides a breeding ground for security vulnerabilities similar to those found in other computer systems. To mitigate this issue, Nest signs firmware updates sent to the device, but the hardware infrastructure lacks proper protection, allowing attackers to install malicious software into the unit. Through a USB connection, we demonstrate how the firmware verification done by the Nest software stack can be bypassed, providing the means to completely alter the behavior of the unit. The compromised Nest Thermostat will then act as a beachhead to attack other nodes within the local network. Also, any information stored within the unit is now available to the attacker, who no longer has to have physical access to the device. Finally, we present a solution to smart device architects and manufacturers aiding the development and deployment of a secure hardware platform. 1 Introduction The concept of Internet of Things (IoT) and wearable devices has been widely accepted in the last few years with an increasing amount of smart devices being designed, fabricated, and deployed. It is estimated that there will be more than 50 billion network connected devices by 2020, the majority of which will be IoT and wearable devices1 . The once science fiction scenes that showed our refrigerators ordering us milk and our washing machines messaging us when laundry needs to be done are now reality. The convenience provided by networked smart devices also breeds security and privacy concerns. Nest founder Tony Fadell claimed in an interview, “We have bank-level security, we encrypt updates, and we have an internal hacker team testing the security ... [the Nest Thermostat] will never take off if people don’t trust it.” However, a deep look into the current IoT and wearable device design flow revealed to us that most of the current security considerations, if any, are put on the application and network level. That is, designers often treat IoT and wearable devices as standard networked devices and try to apply the security protections developed for regular, everyday use computing devices. It is rare to find any work done beyond firmware authentication or encryption. Most IoT and wearable devices collect usage information and other data and send it to a service provider, leading to privacy concerns. Full disclosure of the what is collected is rare, and anything that is actually published is often hidden in the legalese that is the privacy policies and terms of services of the unit In the rest of the paper, we will introduce our work identifying a security vulnerability in the Nest Thermostat, targeting the hardware infrastructure and the hardware-software boundary. We will demonstrate that attackers who understand the hardware can change the boot process of the device in order to upload malicious firmware, effectively bypassing the firmware update verification done by the software. From a positive angle, however, we argue that this same vulnerability offers legitimate users a way to defend themselves against the collection of data thus protecting their privacy and to extend the functionality of the device. 2 The Nest Thermostat The Nest Thermostat is a smart device designed to control a central air conditioning unit based on heuristics and learned behavior. Coupled with a WiFi module, the Nest Thermostat is able connect to the user’s home or office network and interface with the Nest Cloud, thereby allowing for remote control of the unit. It also exhibits a ZigBee module for communication with other Nest devices, but has remained dormant for firmware versions up to the now current 4.2.x series. The Nest Thermostat runs a Linux kernel, coupled with some GNU userland tools, Busybox, other miscellaneous utilities supporting a proprietary stack by Nest Labs. To remain GPL compliant, the modified source code used within the device has been published and is available for download from Nest Lab’s Open Source Compliance page at https://nest.com/legal/compliance, with the notable exception of the C library. A toolchain to build these sources is not provided either. 2.1 User Privacy The Nest Thermostat will collect usage statistics of the device and environmental data and thus “learn” the user’s behavior. This is stored within the unit and also uploaded to the Nest Cloud once the thermostat connects to a network. Not only usage statistics are uploaded, but also system logs and Nest software logs, which contains information such as the user’s Zip Code, device settings, HVAC settings, and wiring configuration. Forensic analysis of the device also yields that the Nest Thermostat has code to prompt the user for information about their place of residence or office. Reports indicate that Nest plans to share this information with energy providers in order to generate energy more efficiently. 2.2 Architecture Overview As a device itself, the Nest Thermostat is divided into two components, a backplate which directly interfaces with the air conditioning unit and a front panel with a screen, a button, a rotary dial and a motion sensor. The operating system runs on the front plate. The backplate contains a STMicroelectronics low power ARM Cortex-M3 microcontroller with 128KiB of flash storage and 16KiB of RAM, coupled with a few driver circuits and an SHT20 temperature and humidity sensor. The backplate communicates with the front plate using a UART. The front panel offers a Texas Instruments (TI) Sitara AM3703 microprocessor, 64MiB of SDRAM, 2Gibit (256MiB) of ECC NAND flash, a ZigBee module and a WiFi module supporting 802.11 b/g/n. The board for this device also offers a Texas Instruments TPS65921B power management module with HS USB capabilities. This part of the Nest has been the target of our research so far, as it contains the most hardware and handles all user data and input. 2.3 Boot Process Upon normal power on conditions, the Sitara AM3703 starts to execute the code in its internal ROM. This code initializes the most basic peripherals, including the General Purpose Memory Controller (GPMC). It then looks for the first stage bootloader, x-loader, and places it into SRAM. Once this operation finishes, the ROM code jumps into x-loader, which proceeds to initialize other peripherals and SDRAM. Afterwards, it copies the second stage bootloader, u-boot, into SDRAM and proceeds to execute it. At this point, u-boot proceeds to initialize the remaining subsystems and executes the uImage in NAND with the configured environment. The system finishes booting from NAND as initialization scripts are executed, services are run, culminating with the loading of the Nest Thermostat proprietary software stack.
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You base all answers on the provided context block. Use only the information in the context block to answer the user's question. How do the two parts of the nest interface? Abstract The Nest Thermostat is a smart home automation device that aims to learn a user’s heating and cooling habits to help optimize scheduling and power usage. With its debut in 2011, Nest has proven to be such a success that Google spent $3.2B to acquire the company. However, the complexity of the infrastructure in the Nest Thermostat provides a breeding ground for security vulnerabilities similar to those found in other computer systems. To mitigate this issue, Nest signs firmware updates sent to the device, but the hardware infrastructure lacks proper protection, allowing attackers to install malicious software into the unit. Through a USB connection, we demonstrate how the firmware verification done by the Nest software stack can be bypassed, providing the means to completely alter the behavior of the unit. The compromised Nest Thermostat will then act as a beachhead to attack other nodes within the local network. Also, any information stored within the unit is now available to the attacker, who no longer has to have physical access to the device. Finally, we present a solution to smart device architects and manufacturers aiding the development and deployment of a secure hardware platform. 1 Introduction The concept of Internet of Things (IoT) and wearable devices has been widely accepted in the last few years with an increasing amount of smart devices being designed, fabricated, and deployed. It is estimated that there will be more than 50 billion network connected devices by 2020, the majority of which will be IoT and wearable devices1 . The once science fiction scenes that showed our refrigerators ordering us milk and our washing machines messaging us when laundry needs to be done are now reality. The convenience provided by networked smart devices also breeds security and privacy concerns. Nest founder Tony Fadell claimed in an interview, “We have bank-level security, we encrypt updates, and we have an internal hacker team testing the security ... [the Nest Thermostat] will never take off if people don’t trust it.” However, a deep look into the current IoT and wearable device design flow revealed to us that most of the current security considerations, if any, are put on the application and network level. That is, designers often treat IoT and wearable devices as standard networked devices and try to apply the security protections developed for regular, everyday use computing devices. It is rare to find any work done beyond firmware authentication or encryption. Most IoT and wearable devices collect usage information and other data and send it to a service provider, leading to privacy concerns. Full disclosure of the what is collected is rare, and anything that is actually published is often hidden in the legalese that is the privacy policies and terms of services of the unit In the rest of the paper, we will introduce our work identifying a security vulnerability in the Nest Thermostat, targeting the hardware infrastructure and the hardware-software boundary. We will demonstrate that attackers who understand the hardware can change the boot process of the device in order to upload malicious firmware, effectively bypassing the firmware update verification done by the software. From a positive angle, however, we argue that this same vulnerability offers legitimate users a way to defend themselves against the collection of data thus protecting their privacy and to extend the functionality of the device. 2 The Nest Thermostat The Nest Thermostat is a smart device designed to control a central air conditioning unit based on heuristics and learned behavior. Coupled with a WiFi module, the Nest Thermostat is able connect to the user’s home or office network and interface with the Nest Cloud, thereby allowing for remote control of the unit. It also exhibits a ZigBee module for communication with other Nest devices, but has remained dormant for firmware versions up to the now current 4.2.x series. The Nest Thermostat runs a Linux kernel, coupled with some GNU userland tools, Busybox, other miscellaneous utilities supporting a proprietary stack by Nest Labs. To remain GPL compliant, the modified source code used within the device has been published and is available for download from Nest Lab’s Open Source Compliance page at https://nest.com/legal/compliance, with the notable exception of the C library. A toolchain to build these sources is not provided either. 2.1 User Privacy The Nest Thermostat will collect usage statistics of the device and environmental data and thus “learn” the user’s behavior. This is stored within the unit and also uploaded to the Nest Cloud once the thermostat connects to a network. Not only usage statistics are uploaded, but also system logs and Nest software logs, which contains information such as the user’s Zip Code, device settings, HVAC settings, and wiring configuration. Forensic analysis of the device also yields that the Nest Thermostat has code to prompt the user for information about their place of residence or office. Reports indicate that Nest plans to share this information with energy providers in order to generate energy more efficiently. 2.2 Architecture Overview As a device itself, the Nest Thermostat is divided into two components, a backplate which directly interfaces with the air conditioning unit and a front panel with a screen, a button, a rotary dial and a motion sensor. The operating system runs on the front plate. The backplate contains a STMicroelectronics low power ARM Cortex-M3 microcontroller with 128KiB of flash storage and 16KiB of RAM, coupled with a few driver circuits and an SHT20 temperature and humidity sensor. The backplate communicates with the front plate using a UART. The front panel offers a Texas Instruments (TI) Sitara AM3703 microprocessor, 64MiB of SDRAM, 2Gibit (256MiB) of ECC NAND flash, a ZigBee module and a WiFi module supporting 802.11 b/g/n. The board for this device also offers a Texas Instruments TPS65921B power management module with HS USB capabilities. This part of the Nest has been the target of our research so far, as it contains the most hardware and handles all user data and input. 2.3 Boot Process Upon normal power on conditions, the Sitara AM3703 starts to execute the code in its internal ROM. This code initializes the most basic peripherals, including the General Purpose Memory Controller (GPMC). It then looks for the first stage bootloader, x-loader, and places it into SRAM. Once this operation finishes, the ROM code jumps into x-loader, which proceeds to initialize other peripherals and SDRAM. Afterwards, it copies the second stage bootloader, u-boot, into SDRAM and proceeds to execute it. At this point, u-boot proceeds to initialize the remaining subsystems and executes the uImage in NAND with the configured environment. The system finishes booting from NAND as initialization scripts are executed, services are run, culminating with the loading of the Nest Thermostat proprietary software stack.
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You base all answers on the provided context block. Use only the information in the context block to answer the user's question.
EVIDENCE:
Abstract The Nest Thermostat is a smart home automation device that aims to learn a user’s heating and cooling habits to help optimize scheduling and power usage. With its debut in 2011, Nest has proven to be such a success that Google spent $3.2B to acquire the company. However, the complexity of the infrastructure in the Nest Thermostat provides a breeding ground for security vulnerabilities similar to those found in other computer systems. To mitigate this issue, Nest signs firmware updates sent to the device, but the hardware infrastructure lacks proper protection, allowing attackers to install malicious software into the unit. Through a USB connection, we demonstrate how the firmware verification done by the Nest software stack can be bypassed, providing the means to completely alter the behavior of the unit. The compromised Nest Thermostat will then act as a beachhead to attack other nodes within the local network. Also, any information stored within the unit is now available to the attacker, who no longer has to have physical access to the device. Finally, we present a solution to smart device architects and manufacturers aiding the development and deployment of a secure hardware platform. 1 Introduction The concept of Internet of Things (IoT) and wearable devices has been widely accepted in the last few years with an increasing amount of smart devices being designed, fabricated, and deployed. It is estimated that there will be more than 50 billion network connected devices by 2020, the majority of which will be IoT and wearable devices1 . The once science fiction scenes that showed our refrigerators ordering us milk and our washing machines messaging us when laundry needs to be done are now reality. The convenience provided by networked smart devices also breeds security and privacy concerns. Nest founder Tony Fadell claimed in an interview, “We have bank-level security, we encrypt updates, and we have an internal hacker team testing the security ... [the Nest Thermostat] will never take off if people don’t trust it.” However, a deep look into the current IoT and wearable device design flow revealed to us that most of the current security considerations, if any, are put on the application and network level. That is, designers often treat IoT and wearable devices as standard networked devices and try to apply the security protections developed for regular, everyday use computing devices. It is rare to find any work done beyond firmware authentication or encryption. Most IoT and wearable devices collect usage information and other data and send it to a service provider, leading to privacy concerns. Full disclosure of the what is collected is rare, and anything that is actually published is often hidden in the legalese that is the privacy policies and terms of services of the unit In the rest of the paper, we will introduce our work identifying a security vulnerability in the Nest Thermostat, targeting the hardware infrastructure and the hardware-software boundary. We will demonstrate that attackers who understand the hardware can change the boot process of the device in order to upload malicious firmware, effectively bypassing the firmware update verification done by the software. From a positive angle, however, we argue that this same vulnerability offers legitimate users a way to defend themselves against the collection of data thus protecting their privacy and to extend the functionality of the device. 2 The Nest Thermostat The Nest Thermostat is a smart device designed to control a central air conditioning unit based on heuristics and learned behavior. Coupled with a WiFi module, the Nest Thermostat is able connect to the user’s home or office network and interface with the Nest Cloud, thereby allowing for remote control of the unit. It also exhibits a ZigBee module for communication with other Nest devices, but has remained dormant for firmware versions up to the now current 4.2.x series. The Nest Thermostat runs a Linux kernel, coupled with some GNU userland tools, Busybox, other miscellaneous utilities supporting a proprietary stack by Nest Labs. To remain GPL compliant, the modified source code used within the device has been published and is available for download from Nest Lab’s Open Source Compliance page at https://nest.com/legal/compliance, with the notable exception of the C library. A toolchain to build these sources is not provided either. 2.1 User Privacy The Nest Thermostat will collect usage statistics of the device and environmental data and thus “learn” the user’s behavior. This is stored within the unit and also uploaded to the Nest Cloud once the thermostat connects to a network. Not only usage statistics are uploaded, but also system logs and Nest software logs, which contains information such as the user’s Zip Code, device settings, HVAC settings, and wiring configuration. Forensic analysis of the device also yields that the Nest Thermostat has code to prompt the user for information about their place of residence or office. Reports indicate that Nest plans to share this information with energy providers in order to generate energy more efficiently. 2.2 Architecture Overview As a device itself, the Nest Thermostat is divided into two components, a backplate which directly interfaces with the air conditioning unit and a front panel with a screen, a button, a rotary dial and a motion sensor. The operating system runs on the front plate. The backplate contains a STMicroelectronics low power ARM Cortex-M3 microcontroller with 128KiB of flash storage and 16KiB of RAM, coupled with a few driver circuits and an SHT20 temperature and humidity sensor. The backplate communicates with the front plate using a UART. The front panel offers a Texas Instruments (TI) Sitara AM3703 microprocessor, 64MiB of SDRAM, 2Gibit (256MiB) of ECC NAND flash, a ZigBee module and a WiFi module supporting 802.11 b/g/n. The board for this device also offers a Texas Instruments TPS65921B power management module with HS USB capabilities. This part of the Nest has been the target of our research so far, as it contains the most hardware and handles all user data and input. 2.3 Boot Process Upon normal power on conditions, the Sitara AM3703 starts to execute the code in its internal ROM. This code initializes the most basic peripherals, including the General Purpose Memory Controller (GPMC). It then looks for the first stage bootloader, x-loader, and places it into SRAM. Once this operation finishes, the ROM code jumps into x-loader, which proceeds to initialize other peripherals and SDRAM. Afterwards, it copies the second stage bootloader, u-boot, into SDRAM and proceeds to execute it. At this point, u-boot proceeds to initialize the remaining subsystems and executes the uImage in NAND with the configured environment. The system finishes booting from NAND as initialization scripts are executed, services are run, culminating with the loading of the Nest Thermostat proprietary software stack.
USER:
How do the two parts of the nest interface?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 22 | 9 | 1,119 | null | 645 |
Use only the provided context block to find answers to the user prompt. Do not use external sources.
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What did FCC have to do with 230?
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Section 230 was enacted in 1996 in response to a trial court ruling that allowed an online platform to be subject to liability for hosting defamatory speech, in part because the platform had said it would police its site for unwanted speech. Congress was concerned that this ruling created a perverse incentive for sites to refrain from monitoring content to avoid liability. Section 230 can be seen as speech-protective: by barring lawsuits that would punish platforms for hosting speech, it may encourage platforms to err on the side of hosting more content, while still allowing sites to take down content they see as objectionable. To this end, Section 230 contains two different provisions that courts have generally viewed as two distinct liability shields. First, Section 230(c)(1) states that interactive computer service providers and users may not “be treated as the publisher or speaker of any information provided by another” person. This provision has been broadly interpreted to bar a wide variety of suits that would treat service providers as the publisher of another’s content, including claims of defamation, negligence, discrimination under the Civil Rights Act of 1964, and state criminal prosecutions. However, if a site helps develop the unlawful content, courts have ruled that Section 230(c)(1) immunity does not apply. Accordingly, courts have, for example, rejected applying Section 230 to cases brought by the FTC against a defendant website that solicited or was involved in publishing allegedly unlawful content. More generally, Section 230 will not bar suits that seek to hold sites liable for their own conduct, rather than another’s content. But courts have said that acts inherent to publishing, such as reviewing, suggesting, and sometimes even editing content, may not, by themselves, qualify as helping develop the challenged content. As a consequence, Section 230(c)(1) immunity can apply regardless of whether the site chooses to actively police content or whether it chooses to take a more hands-off approach. Second, Section 230(c)(2) provides that interactive computer service providers and users may not be “held liable” for any voluntary, “good faith” action “to restrict access to or availability of material that the provider or user considers to be obscene, lewd, lascivious, filthy, excessively violent, harassing, or otherwise objectionable.” Section 230(c)(2) also immunizes providing “the technical means to restrict access” to objectionable material. Unlike Section 230(c)(1), Section 230(c)(2) applies only to good faith actions to restrict objectionable material. Courts have ruled that allegations of anticompetitive motives can demonstrate bad faith, disqualifying sites from claiming Section 230(c)(2) immunity. There are, however, relatively few published federal court cases interpreting this provision. Because Section 230(c)(2) contains a good-faith requirement and Section 230(c)(1) does not, some courts have recognized the importance of determining when each immunity provision applies. At least one decision suggests that Section 230(c)(2) applies when a service provider “does filter out offensive material,” while Section 230(c)(1) applies when providers “refrain from filtering or censoring the information on their sites.” But, as one scholar has noted, other courts have cited Section 230(c)(1) when dismissing claims predicated on takedowns. Another possibility is that Section 230(c)(1) does not apply when the plaintiff’s own content is at issue—that is, while Section 230(c)(1) immunity only applies if a third party created the disputed content, Section 230(c)(2) can apply when a person sues a site for taking down the plaintiff’s own content. Again, however, other decisions suggest that courts may apply Section 230(c)(1) even when the suit involves the plaintiff’s own content. Athird view is that Section 230(c)(2) might apply if the provider helps develop content and is therefore ineligible for (c)(1) immunity. In short, court rulings are inconsistent on the question of when each of the two immunity provisions governs. Section230(e)expressly states that the law will not bar liability in certain cases.Defendants may not claim Section 230 immunity in federal criminal prosecutions, cases involving intellectual property laws, suits under the Electronic Communications Privacy Act or “similar” state laws, and certain civil actions and state criminal prosecutions relating to sex trafficking. If Section 230’s liability shield does not apply, the person being sued will not automatically be held liable. Instead, it means only that courts can continue to adjudicate the case. The EO begins by stating in Section 1 the President’s belief that online platforms are engaging in “selective censorship,” harming national discourse and restricting Americans’ speech. Section 2 turns to the interpretation of Section 230(c), arguing that the “scope” of this immunity provision “should be clarified” and the law should not be extended to platforms that “engage in deceptive or pretextual actions” to censor “certain viewpoints.” The EO maintains that Congress intended Section 230(c) to only protect service providers that engage in “Good Samaritan” blocking of harmful content. Section 2 further states that providers should not be entitled to Section 230(c)(2) immunity if they remove content without acting in “good faith,” including by taking “deceptive or pretextual actions (often contrary to their stated terms of service)” to suppress certain viewpoints. Section 2 also directs the Commerce Secretary, “in consultation with the Attorney General, and acting through the National Telecommunications and Information Administration (NTIA),” to request the FCC to issue regulations interpreting Section 230. Among other things, the EO, perhaps in response to the Section 230 jurisprudence discussed above, specifies that FCC’s proposed regulations should clarify: (1) “the interaction between” Section 230(c)(1) and (c)(2) to explain when a service provider that cannot obtain Section 230(c)(2) immunity is also ineligible for protection under (c)(1); and (2) the meaning of “good faith” in Section 230(c)(2), including whether violating terms of service or failing to provide procedural protections qualifies as bad faith. Section 4 of the EO instructs the FTC to “consider taking action, as appropriate and consistent with applicable law, to prohibit unfair or deceptive acts or practices.” Specifically, the EO suggests that if platforms “restrict speech in ways that do not align with those entities’ public representations about” how they monitor content on their sites, these acts may qualify as unfair or deceptive practices under the FTC Act. The EO also directs the FTC to consider whether complaints of “online censorship” received by the White House “allege violations of law,” and whether to develop a report on these complaints. The other provisions of the EO assign additional tasks to more executive departments. Section 3 of the EO requires agency review of federal spending on advertising and marketing on online platforms, and Sections 5 and 6 contain instructions for the Attorney General to establish a working group and propose federal legislation to implement the policies announced in the EO.
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System instructions: [Use only the provided context block to find answers to the user prompt. Do not use external sources.] User query: [What did FCC have to do with 230?] Text: [Section 230 was enacted in 1996 in response to a trial court ruling that allowed an online platform to be subject to liability for hosting defamatory speech, in part because the platform had said it would police its site for unwanted speech. Congress was concerned that this ruling created a perverse incentive for sites to refrain from monitoring content to avoid liability. Section 230 can be seen as speech-protective: by barring lawsuits that would punish platforms for hosting speech, it may encourage platforms to err on the side of hosting more content, while still allowing sites to take down content they see as objectionable. To this end, Section 230 contains two different provisions that courts have generally viewed as two distinct liability shields. First, Section 230(c)(1) states that interactive computer service providers and users may not “be treated as the publisher or speaker of any information provided by another” person. This provision has been broadly interpreted to bar a wide variety of suits that would treat service providers as the publisher of another’s content, including claims of defamation, negligence, discrimination under the Civil Rights Act of 1964, and state criminal prosecutions. However, if a site helps develop the unlawful content, courts have ruled that Section 230(c)(1) immunity does not apply. Accordingly, courts have, for example, rejected applying Section 230 to cases brought by the FTC against a defendant website that solicited or was involved in publishing allegedly unlawful content. More generally, Section 230 will not bar suits that seek to hold sites liable for their own conduct, rather than another’s content. But courts have said that acts inherent to publishing, such as reviewing, suggesting, and sometimes even editing content, may not, by themselves, qualify as helping develop the challenged content. As a consequence, Section 230(c)(1) immunity can apply regardless of whether the site chooses to actively police content or whether it chooses to take a more hands-off approach. Second, Section 230(c)(2) provides that interactive computer service providers and users may not be “held liable” for any voluntary, “good faith” action “to restrict access to or availability of material that the provider or user considers to be obscene, lewd, lascivious, filthy, excessively violent, harassing, or otherwise objectionable.” Section 230(c)(2) also immunizes providing “the technical means to restrict access” to objectionable material. Unlike Section 230(c)(1), Section 230(c)(2) applies only to good faith actions to restrict objectionable material. Courts have ruled that allegations of anticompetitive motives can demonstrate bad faith, disqualifying sites from claiming Section 230(c)(2) immunity. There are, however, relatively few published federal court cases interpreting this provision. Because Section 230(c)(2) contains a good-faith requirement and Section 230(c)(1) does not, some courts have recognized the importance of determining when each immunity provision applies. At least one decision suggests that Section 230(c)(2) applies when a service provider “does filter out offensive material,” while Section 230(c)(1) applies when providers “refrain from filtering or censoring the information on their sites.” But, as one scholar has noted, other courts have cited Section 230(c)(1) when dismissing claims predicated on takedowns. Another possibility is that Section 230(c)(1) does not apply when the plaintiff’s own content is at issue—that is, while Section 230(c)(1) immunity only applies if a third party created the disputed content, Section 230(c)(2) can apply when a person sues a site for taking down the plaintiff’s own content. Again, however, other decisions suggest that courts may apply Section 230(c)(1) even when the suit involves the plaintiff’s own content. Athird view is that Section 230(c)(2) might apply if the provider helps develop content and is therefore ineligible for (c)(1) immunity. In short, court rulings are inconsistent on the question of when each of the two immunity provisions governs. Section230(e)expressly states that the law will not bar liability in certain cases.Defendants may not claim Section 230 immunity in federal criminal prosecutions, cases involving intellectual property laws, suits under the Electronic Communications Privacy Act or “similar” state laws, and certain civil actions and state criminal prosecutions relating to sex trafficking. If Section 230’s liability shield does not apply, the person being sued will not automatically be held liable. Instead, it means only that courts can continue to adjudicate the case. The EO begins by stating in Section 1 the President’s belief that online platforms are engaging in “selective censorship,” harming national discourse and restricting Americans’ speech. Section 2 turns to the interpretation of Section 230(c), arguing that the “scope” of this immunity provision “should be clarified” and the law should not be extended to platforms that “engage in deceptive or pretextual actions” to censor “certain viewpoints.” The EO maintains that Congress intended Section 230(c) to only protect service providers that engage in “Good Samaritan” blocking of harmful content. Section 2 further states that providers should not be entitled to Section 230(c)(2) immunity if they remove content without acting in “good faith,” including by taking “deceptive or pretextual actions (often contrary to their stated terms of service)” to suppress certain viewpoints. Section 2 also directs the Commerce Secretary, “in consultation with the Attorney General, and acting through the National Telecommunications and Information Administration (NTIA),” to request the FCC to issue regulations interpreting Section 230. Among other things, the EO, perhaps in response to the Section 230 jurisprudence discussed above, specifies that FCC’s proposed regulations should clarify: (1) “the interaction between” Section 230(c)(1) and (c)(2) to explain when a service provider that cannot obtain Section 230(c)(2) immunity is also ineligible for protection under (c)(1); and (2) the meaning of “good faith” in Section 230(c)(2), including whether violating terms of service or failing to provide procedural protections qualifies as bad faith. Section 4 of the EO instructs the FTC to “consider taking action, as appropriate and consistent with applicable law, to prohibit unfair or deceptive acts or practices.” Specifically, the EO suggests that if platforms “restrict speech in ways that do not align with those entities’ public representations about” how they monitor content on their sites, these acts may qualify as unfair or deceptive practices under the FTC Act. The EO also directs the FTC to consider whether complaints of “online censorship” received by the White House “allege violations of law,” and whether to develop a report on these complaints. The other provisions of the EO assign additional tasks to more executive departments. Section 3 of the EO requires agency review of federal spending on advertising and marketing on online platforms, and Sections 5 and 6 contain instructions for the Attorney General to establish a working group and propose federal legislation to implement the policies announced in the EO.]
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Use only the provided context block to find answers to the user prompt. Do not use external sources.
EVIDENCE:
Section 230 was enacted in 1996 in response to a trial court ruling that allowed an online platform to be subject to liability for hosting defamatory speech, in part because the platform had said it would police its site for unwanted speech. Congress was concerned that this ruling created a perverse incentive for sites to refrain from monitoring content to avoid liability. Section 230 can be seen as speech-protective: by barring lawsuits that would punish platforms for hosting speech, it may encourage platforms to err on the side of hosting more content, while still allowing sites to take down content they see as objectionable. To this end, Section 230 contains two different provisions that courts have generally viewed as two distinct liability shields. First, Section 230(c)(1) states that interactive computer service providers and users may not “be treated as the publisher or speaker of any information provided by another” person. This provision has been broadly interpreted to bar a wide variety of suits that would treat service providers as the publisher of another’s content, including claims of defamation, negligence, discrimination under the Civil Rights Act of 1964, and state criminal prosecutions. However, if a site helps develop the unlawful content, courts have ruled that Section 230(c)(1) immunity does not apply. Accordingly, courts have, for example, rejected applying Section 230 to cases brought by the FTC against a defendant website that solicited or was involved in publishing allegedly unlawful content. More generally, Section 230 will not bar suits that seek to hold sites liable for their own conduct, rather than another’s content. But courts have said that acts inherent to publishing, such as reviewing, suggesting, and sometimes even editing content, may not, by themselves, qualify as helping develop the challenged content. As a consequence, Section 230(c)(1) immunity can apply regardless of whether the site chooses to actively police content or whether it chooses to take a more hands-off approach. Second, Section 230(c)(2) provides that interactive computer service providers and users may not be “held liable” for any voluntary, “good faith” action “to restrict access to or availability of material that the provider or user considers to be obscene, lewd, lascivious, filthy, excessively violent, harassing, or otherwise objectionable.” Section 230(c)(2) also immunizes providing “the technical means to restrict access” to objectionable material. Unlike Section 230(c)(1), Section 230(c)(2) applies only to good faith actions to restrict objectionable material. Courts have ruled that allegations of anticompetitive motives can demonstrate bad faith, disqualifying sites from claiming Section 230(c)(2) immunity. There are, however, relatively few published federal court cases interpreting this provision. Because Section 230(c)(2) contains a good-faith requirement and Section 230(c)(1) does not, some courts have recognized the importance of determining when each immunity provision applies. At least one decision suggests that Section 230(c)(2) applies when a service provider “does filter out offensive material,” while Section 230(c)(1) applies when providers “refrain from filtering or censoring the information on their sites.” But, as one scholar has noted, other courts have cited Section 230(c)(1) when dismissing claims predicated on takedowns. Another possibility is that Section 230(c)(1) does not apply when the plaintiff’s own content is at issue—that is, while Section 230(c)(1) immunity only applies if a third party created the disputed content, Section 230(c)(2) can apply when a person sues a site for taking down the plaintiff’s own content. Again, however, other decisions suggest that courts may apply Section 230(c)(1) even when the suit involves the plaintiff’s own content. Athird view is that Section 230(c)(2) might apply if the provider helps develop content and is therefore ineligible for (c)(1) immunity. In short, court rulings are inconsistent on the question of when each of the two immunity provisions governs. Section230(e)expressly states that the law will not bar liability in certain cases.Defendants may not claim Section 230 immunity in federal criminal prosecutions, cases involving intellectual property laws, suits under the Electronic Communications Privacy Act or “similar” state laws, and certain civil actions and state criminal prosecutions relating to sex trafficking. If Section 230’s liability shield does not apply, the person being sued will not automatically be held liable. Instead, it means only that courts can continue to adjudicate the case. The EO begins by stating in Section 1 the President’s belief that online platforms are engaging in “selective censorship,” harming national discourse and restricting Americans’ speech. Section 2 turns to the interpretation of Section 230(c), arguing that the “scope” of this immunity provision “should be clarified” and the law should not be extended to platforms that “engage in deceptive or pretextual actions” to censor “certain viewpoints.” The EO maintains that Congress intended Section 230(c) to only protect service providers that engage in “Good Samaritan” blocking of harmful content. Section 2 further states that providers should not be entitled to Section 230(c)(2) immunity if they remove content without acting in “good faith,” including by taking “deceptive or pretextual actions (often contrary to their stated terms of service)” to suppress certain viewpoints. Section 2 also directs the Commerce Secretary, “in consultation with the Attorney General, and acting through the National Telecommunications and Information Administration (NTIA),” to request the FCC to issue regulations interpreting Section 230. Among other things, the EO, perhaps in response to the Section 230 jurisprudence discussed above, specifies that FCC’s proposed regulations should clarify: (1) “the interaction between” Section 230(c)(1) and (c)(2) to explain when a service provider that cannot obtain Section 230(c)(2) immunity is also ineligible for protection under (c)(1); and (2) the meaning of “good faith” in Section 230(c)(2), including whether violating terms of service or failing to provide procedural protections qualifies as bad faith. Section 4 of the EO instructs the FTC to “consider taking action, as appropriate and consistent with applicable law, to prohibit unfair or deceptive acts or practices.” Specifically, the EO suggests that if platforms “restrict speech in ways that do not align with those entities’ public representations about” how they monitor content on their sites, these acts may qualify as unfair or deceptive practices under the FTC Act. The EO also directs the FTC to consider whether complaints of “online censorship” received by the White House “allege violations of law,” and whether to develop a report on these complaints. The other provisions of the EO assign additional tasks to more executive departments. Section 3 of the EO requires agency review of federal spending on advertising and marketing on online platforms, and Sections 5 and 6 contain instructions for the Attorney General to establish a working group and propose federal legislation to implement the policies announced in the EO.
USER:
What did FCC have to do with 230?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 18 | 8 | 1,087 | null | 252 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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My sister and her dog live in NYC. I've visited there and have always been fascinated with their tall buildings. Then I thought...someone has to clean those! Then next thing you know, window washing robotos popped up on my feed. How do these robots work? Also what does this mean for the people who do those jobs?
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The skyscraper window-washing robots are here Skyline Robotics claims its autonomous robot Ozmo can clean windows three times faster than humans alone. By Mack DeGeurin Posted on Aug 28, 2024 10:06 AM EDT Share Tourists and workers alike jostling their way through New York’s bustling midtown may notice an odd sight next time they look up. Dozens of floors above ground, the world’s first commercial window-cleaning-robot will be thrusting its two white mechanical arms back and forth, soapy squeegees in hand. Skyline Robotics, the New York-based company behind the “Ozmo” cleaning robot, believe machines like theirs are faster and safer than traditional cleaning methods and could help address the potential shortage of human skyscraper window washers in coming years. It’s just the latest example of artificial intelligence and robotics merging together to perform real-word tasks once confined to people. Caption: The Ozmo robot uses a combination of computer vision, Lidar, and force sensors to determine when and how to clean windows. Credit: Skyline Robotics Starting this week, Skyline’s Ozmo robot will get to work cleaning windows at 1133 Avenue of the Americas, a 45-story Class A skyscraper owned and managed by the Durst Organization near New York’s Bryant Park. Ozmo was previously beta tested across several buildings in the city and Tel Aviv, Israel, but Skyline tells Popular Science this marks the first full-time deployment on an autonomous window-cleaning robot. Early prototypes of window-cleaning robots have been around for years, with some even tested on the original World Trade Center buildings. But those predecessors were imprecise and required a human reviewer to follow up and clean up messy spots the machine missed. Since then, modern skyscrapers have been built with sharper angles and more artistic designs, which can make cleaning them even more skill intensive. Ozmo uses Lidar and computer vision to ‘see’ what it’s cleaning Ozmo improves on older robot designs thanks to recent advances in robotics and artificial intelligence. The robot cleaner uses a combination of Lidar and computer vision, similar to what’s used in some autonomous vehicles, to scan a building’s surface and its particular curve and edge areas. Onboard force sensors let the robot determine how much pressure it needs to apply to clean a particular window most effectively. AI software, meanwhile, helps Ozmo stabilize itself even when presented with heavy gusts of wind. Since its initial beta tests, a Skyline spokesperson says they have equipped Ozmo with additional ultrasonic sensors and increased its robustness in order to properly handle taller buildings. And while the robot operates autonomously, Skyline says a team of human supervisors located on the building’s roof will still remotely monitor it. “We’re delivering the future of façade maintenance as Ozmo and human window cleaners work in unison to protect the health of buildings faster and safer than existing solutions,” Skyline Robotics CEO Michael Brown said. A Skyline spokesperson told Popular Science their product is a “robot as a service platform” and that total pricing will depend on the overall size of the surface’s being cleaned. Robots could make window cleaning even safer Window washing, especially amongst Manhattan’s concrete behemoths, isn’t for the faint of heart. Cleaners often operate hundreds of feet in the air supported by harness and working in tight corridors. Strong winds and other environmental factors can make an already nerve-racking job even more stress inducing. But even though harrowing videos occasionally surface showing workers dangerously dangling from rooftops or falling, window-washing is actually statistically safer than some might expect. Data compiled by the Occupational Safety and Health Administration (OSHA) lists only 20 fatalities involving window washers nationally between 2019 and 2023. Still, Skyline argues its robotics solution can make the industry even faster and more efficient. The company claims its human-aided robotic approach can clean windows three times faster than traditional window cleaning methods. Aside from pure speed, robots might one-day need to help fill in gaps in the aging window-asking workforce. A recent analysis of census and Department of Labor data compiled by the online job resource firm Zippia estimates around 70% of US-based window cleaners are over 40 years old. Just 9% of workers were reportedly between the ages of 20 and 30. At the same time, the appetite for new towers doesn’t seem to be subsiding. There are currently five towers over 980 feet currently under construction in Manhattan and many more smaller ones. Ozmo arrives during a time of increased automation nationwide, both in white collar service jobs and physical labor. Advanced large language models like those created by OpenAI and Google are already disrupting work and contributing to layoffs in the tech industry and beyond. Larger humanoid-style robots, though still nascent, may increasingly take on work once left to humans in manufacturing sectors. How human workers and labor groups respond to those impending changes could dictate how advancements in robotics evolve in the coming years. Skyline isn’t necessarily waiting for the dust to settle. The company says it has plans to expand Ozmo to buildings in Japan, Singapore, and London, moving forward.
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[question] My sister and her dog live in NYC. I've visited there and have always been fascinated with their tall buildings. Then I thought...someone has to clean those! Then next thing you know, window washing robotos popped up on my feed. How do these robots work? Also what does this mean for the people who do those jobs? ===================== [text] The skyscraper window-washing robots are here Skyline Robotics claims its autonomous robot Ozmo can clean windows three times faster than humans alone. By Mack DeGeurin Posted on Aug 28, 2024 10:06 AM EDT Share Tourists and workers alike jostling their way through New York’s bustling midtown may notice an odd sight next time they look up. Dozens of floors above ground, the world’s first commercial window-cleaning-robot will be thrusting its two white mechanical arms back and forth, soapy squeegees in hand. Skyline Robotics, the New York-based company behind the “Ozmo” cleaning robot, believe machines like theirs are faster and safer than traditional cleaning methods and could help address the potential shortage of human skyscraper window washers in coming years. It’s just the latest example of artificial intelligence and robotics merging together to perform real-word tasks once confined to people. Caption: The Ozmo robot uses a combination of computer vision, Lidar, and force sensors to determine when and how to clean windows. Credit: Skyline Robotics Starting this week, Skyline’s Ozmo robot will get to work cleaning windows at 1133 Avenue of the Americas, a 45-story Class A skyscraper owned and managed by the Durst Organization near New York’s Bryant Park. Ozmo was previously beta tested across several buildings in the city and Tel Aviv, Israel, but Skyline tells Popular Science this marks the first full-time deployment on an autonomous window-cleaning robot. Early prototypes of window-cleaning robots have been around for years, with some even tested on the original World Trade Center buildings. But those predecessors were imprecise and required a human reviewer to follow up and clean up messy spots the machine missed. Since then, modern skyscrapers have been built with sharper angles and more artistic designs, which can make cleaning them even more skill intensive. Ozmo uses Lidar and computer vision to ‘see’ what it’s cleaning Ozmo improves on older robot designs thanks to recent advances in robotics and artificial intelligence. The robot cleaner uses a combination of Lidar and computer vision, similar to what’s used in some autonomous vehicles, to scan a building’s surface and its particular curve and edge areas. Onboard force sensors let the robot determine how much pressure it needs to apply to clean a particular window most effectively. AI software, meanwhile, helps Ozmo stabilize itself even when presented with heavy gusts of wind. Since its initial beta tests, a Skyline spokesperson says they have equipped Ozmo with additional ultrasonic sensors and increased its robustness in order to properly handle taller buildings. And while the robot operates autonomously, Skyline says a team of human supervisors located on the building’s roof will still remotely monitor it. “We’re delivering the future of façade maintenance as Ozmo and human window cleaners work in unison to protect the health of buildings faster and safer than existing solutions,” Skyline Robotics CEO Michael Brown said. A Skyline spokesperson told Popular Science their product is a “robot as a service platform” and that total pricing will depend on the overall size of the surface’s being cleaned. Robots could make window cleaning even safer Window washing, especially amongst Manhattan’s concrete behemoths, isn’t for the faint of heart. Cleaners often operate hundreds of feet in the air supported by harness and working in tight corridors. Strong winds and other environmental factors can make an already nerve-racking job even more stress inducing. But even though harrowing videos occasionally surface showing workers dangerously dangling from rooftops or falling, window-washing is actually statistically safer than some might expect. Data compiled by the Occupational Safety and Health Administration (OSHA) lists only 20 fatalities involving window washers nationally between 2019 and 2023. Still, Skyline argues its robotics solution can make the industry even faster and more efficient. The company claims its human-aided robotic approach can clean windows three times faster than traditional window cleaning methods. Aside from pure speed, robots might one-day need to help fill in gaps in the aging window-asking workforce. A recent analysis of census and Department of Labor data compiled by the online job resource firm Zippia estimates around 70% of US-based window cleaners are over 40 years old. Just 9% of workers were reportedly between the ages of 20 and 30. At the same time, the appetite for new towers doesn’t seem to be subsiding. There are currently five towers over 980 feet currently under construction in Manhattan and many more smaller ones. Ozmo arrives during a time of increased automation nationwide, both in white collar service jobs and physical labor. Advanced large language models like those created by OpenAI and Google are already disrupting work and contributing to layoffs in the tech industry and beyond. Larger humanoid-style robots, though still nascent, may increasingly take on work once left to humans in manufacturing sectors. How human workers and labor groups respond to those impending changes could dictate how advancements in robotics evolve in the coming years. Skyline isn’t necessarily waiting for the dust to settle. The company says it has plans to expand Ozmo to buildings in Japan, Singapore, and London, moving forward. https://www.popsci.com/technology/window-washing-robot-skyscrapers/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
The skyscraper window-washing robots are here Skyline Robotics claims its autonomous robot Ozmo can clean windows three times faster than humans alone. By Mack DeGeurin Posted on Aug 28, 2024 10:06 AM EDT Share Tourists and workers alike jostling their way through New York’s bustling midtown may notice an odd sight next time they look up. Dozens of floors above ground, the world’s first commercial window-cleaning-robot will be thrusting its two white mechanical arms back and forth, soapy squeegees in hand. Skyline Robotics, the New York-based company behind the “Ozmo” cleaning robot, believe machines like theirs are faster and safer than traditional cleaning methods and could help address the potential shortage of human skyscraper window washers in coming years. It’s just the latest example of artificial intelligence and robotics merging together to perform real-word tasks once confined to people. Caption: The Ozmo robot uses a combination of computer vision, Lidar, and force sensors to determine when and how to clean windows. Credit: Skyline Robotics Starting this week, Skyline’s Ozmo robot will get to work cleaning windows at 1133 Avenue of the Americas, a 45-story Class A skyscraper owned and managed by the Durst Organization near New York’s Bryant Park. Ozmo was previously beta tested across several buildings in the city and Tel Aviv, Israel, but Skyline tells Popular Science this marks the first full-time deployment on an autonomous window-cleaning robot. Early prototypes of window-cleaning robots have been around for years, with some even tested on the original World Trade Center buildings. But those predecessors were imprecise and required a human reviewer to follow up and clean up messy spots the machine missed. Since then, modern skyscrapers have been built with sharper angles and more artistic designs, which can make cleaning them even more skill intensive. Ozmo uses Lidar and computer vision to ‘see’ what it’s cleaning Ozmo improves on older robot designs thanks to recent advances in robotics and artificial intelligence. The robot cleaner uses a combination of Lidar and computer vision, similar to what’s used in some autonomous vehicles, to scan a building’s surface and its particular curve and edge areas. Onboard force sensors let the robot determine how much pressure it needs to apply to clean a particular window most effectively. AI software, meanwhile, helps Ozmo stabilize itself even when presented with heavy gusts of wind. Since its initial beta tests, a Skyline spokesperson says they have equipped Ozmo with additional ultrasonic sensors and increased its robustness in order to properly handle taller buildings. And while the robot operates autonomously, Skyline says a team of human supervisors located on the building’s roof will still remotely monitor it. “We’re delivering the future of façade maintenance as Ozmo and human window cleaners work in unison to protect the health of buildings faster and safer than existing solutions,” Skyline Robotics CEO Michael Brown said. A Skyline spokesperson told Popular Science their product is a “robot as a service platform” and that total pricing will depend on the overall size of the surface’s being cleaned. Robots could make window cleaning even safer Window washing, especially amongst Manhattan’s concrete behemoths, isn’t for the faint of heart. Cleaners often operate hundreds of feet in the air supported by harness and working in tight corridors. Strong winds and other environmental factors can make an already nerve-racking job even more stress inducing. But even though harrowing videos occasionally surface showing workers dangerously dangling from rooftops or falling, window-washing is actually statistically safer than some might expect. Data compiled by the Occupational Safety and Health Administration (OSHA) lists only 20 fatalities involving window washers nationally between 2019 and 2023. Still, Skyline argues its robotics solution can make the industry even faster and more efficient. The company claims its human-aided robotic approach can clean windows three times faster than traditional window cleaning methods. Aside from pure speed, robots might one-day need to help fill in gaps in the aging window-asking workforce. A recent analysis of census and Department of Labor data compiled by the online job resource firm Zippia estimates around 70% of US-based window cleaners are over 40 years old. Just 9% of workers were reportedly between the ages of 20 and 30. At the same time, the appetite for new towers doesn’t seem to be subsiding. There are currently five towers over 980 feet currently under construction in Manhattan and many more smaller ones. Ozmo arrives during a time of increased automation nationwide, both in white collar service jobs and physical labor. Advanced large language models like those created by OpenAI and Google are already disrupting work and contributing to layoffs in the tech industry and beyond. Larger humanoid-style robots, though still nascent, may increasingly take on work once left to humans in manufacturing sectors. How human workers and labor groups respond to those impending changes could dictate how advancements in robotics evolve in the coming years. Skyline isn’t necessarily waiting for the dust to settle. The company says it has plans to expand Ozmo to buildings in Japan, Singapore, and London, moving forward.
USER:
My sister and her dog live in NYC. I've visited there and have always been fascinated with their tall buildings. Then I thought...someone has to clean those! Then next thing you know, window washing robotos popped up on my feed. How do these robots work? Also what does this mean for the people who do those jobs?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 57 | 838 | null | 773 |
You must only respond with information found in the text block. You must begin with an introduction paragraph and finish with a concluding paragraph. The body must only be bullet points.
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Can you provide a summary of the text, focusing on Lawrence G. Roberts' and Leonard Kleinrock's contributions to the origin of the internet?
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The first recorded description of the social interactions that could be enabled through networking was a series of memos written by J.C.R. Licklider of MIT in August 1962 discussing his “Galactic Network” concept. He envisioned a globally interconnected set of computers through which everyone could quickly access data and programs from any site. In spirit, the concept was very much like the Internet of today. Licklider was the first head of the computer research program at DARPA,4 starting in October 1962. While at DARPA he convinced his successors at DARPA, Ivan Sutherland, Bob Taylor, and MIT researcher Lawrence G. Roberts, of the importance of this networking concept. Leonard Kleinrock at MIT published the first paper on packet switching theory in July 1961 and the first book on the subject in 1964. Kleinrock convinced Roberts of the theoretical feasibility of communications using packets rather than circuits, which was a major step along the path towards computer networking. The other key step was to make the computers talk together. To explore this, in 1965 working with Thomas Merrill, Roberts connected the TX-2 computer in Mass. to the Q-32 in California with a low speed dial-up telephone line creating the first (however small) wide-area computer network ever built. The result of this experiment was the realization that the time-shared computers could work well together, running programs and retrieving data as necessary on the remote machine, but that the circuit switched telephone system was totally inadequate for the job. Kleinrock’s conviction of the need for packet switching was confirmed. In late 1966 Roberts went to DARPA to develop the computer network concept and quickly put together his plan for the “ARPANET”, publishing it in 1967. At the conference where he presented the paper, there was also a paper on a packet network concept from the UK by Donald Davies and Roger Scantlebury of NPL. Scantlebury told Roberts about the NPL work as well as that of Paul Baran and others at RAND. The RAND group had written a paper on packet switching networks for secure voice in the military in 1964. It happened that the work at MIT (1961-1967), at RAND (1962-1965), and at NPL (1964-1967) had all proceeded in parallel without any of the researchers knowing about the other work. The word “packet” was adopted from the work at NPL and the proposed line speed to be used in the ARPANET design was upgraded from 2.4 kbps to 50 kbps.5 In August 1968, after Roberts and the DARPA funded community had refined the overall structure and specifications for the ARPANET, an RFQ was released by DARPA for the development of one of the key components, the packet switches called Interface Message Processors (IMP’s). The RFQ was won in December 1968 by a group headed by Frank Heart at Bolt Beranek and Newman (BBN). As the BBN team worked on the IMP’s with Bob Kahn playing a major role in the overall ARPANET architectural design, the network topology and economics were designed and optimized by Roberts working with Howard Frank and his team at Network Analysis Corporation, and the network measurement system was prepared by Kleinrock’s team at UCLA.6 Due to Kleinrock’s early development of packet switching theory and his focus on analysis, design and measurement, his Network Measurement Center at UCLA was selected to be the first node on the ARPANET. All this came together in September 1969 when BBN installed the first IMP at UCLA and the first host computer was connected. Doug Engelbart’s project on “Augmentation of Human Intellect” (which included NLS, an early hypertext system) at Stanford Research Institute (SRI) provided a second node. SRI supported the Network Information Center, led by Elizabeth (Jake) Feinler and including functions such as maintaining tables of host name to address mapping as well as a directory of the RFC’s. One month later, when SRI was connected to the ARPANET, the first host-to-host message was sent from Kleinrock’s laboratory to SRI. Two more nodes were added at UC Santa Barbara and University of Utah. These last two nodes incorporated application visualization projects, with Glen Culler and Burton Fried at UCSB investigating methods for display of mathematical functions using storage displays to deal with the problem of refresh over the net, and Robert Taylor and Ivan Sutherland at Utah investigating methods of 3-D representations over the net. Thus, by the end of 1969, four host computers were connected together into the initial ARPANET, and the budding Internet was off the ground. Even at this early stage, it should be noted that the networking research incorporated both work on the underlying network and work on how to utilize the network. This tradition continues to this day. Computers were added quickly to the ARPANET during the following years, and work proceeded on completing a functionally complete Host-to-Host protocol and other network software. In December 1970 the Network Working Group (NWG) working under S. Crocker finished the initial ARPANET Host-to-Host protocol, called the Network Control Protocol (NCP). As the ARPANET sites completed implementing NCP during the period 1971-1972, the network users finally could begin to develop applications. In October 1972, Kahn organized a large, very successful demonstration of the ARPANET at the International Computer Communication Conference (ICCC). This was the first public demonstration of this new network technology to the public. It was also in 1972 that the initial “hot” application, electronic mail, was introduced. In March Ray Tomlinson at BBN wrote the basic email message send and read software, motivated by the need of the ARPANET developers for an easy coordination mechanism. In July, Roberts expanded its utility by writing the first email utility program to list, selectively read, file, forward, and respond to messages. From there email took off as the largest network application for over a decade. This was a harbinger of the kind of activity we see on the World Wide Web today, namely, the enormous growth of all kinds of “people-to-people” traffic.
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You must only respond with information found in the text block. You must begin with an introduction paragraph and finish with a concluding paragraph. The body must only be bullet points. Can you provide a summary of the text, focusing on Lawrence G. Roberts' and Leonard Kleinrock's contributions to the origin of the internet? The first recorded description of the social interactions that could be enabled through networking was a series of memos written by J.C.R. Licklider of MIT in August 1962 discussing his “Galactic Network” concept. He envisioned a globally interconnected set of computers through which everyone could quickly access data and programs from any site. In spirit, the concept was very much like the Internet of today. Licklider was the first head of the computer research program at DARPA,4 starting in October 1962. While at DARPA he convinced his successors at DARPA, Ivan Sutherland, Bob Taylor, and MIT researcher Lawrence G. Roberts, of the importance of this networking concept. Leonard Kleinrock at MIT published the first paper on packet switching theory in July 1961 and the first book on the subject in 1964. Kleinrock convinced Roberts of the theoretical feasibility of communications using packets rather than circuits, which was a major step along the path towards computer networking. The other key step was to make the computers talk together. To explore this, in 1965 working with Thomas Merrill, Roberts connected the TX-2 computer in Mass. to the Q-32 in California with a low speed dial-up telephone line creating the first (however small) wide-area computer network ever built. The result of this experiment was the realization that the time-shared computers could work well together, running programs and retrieving data as necessary on the remote machine, but that the circuit switched telephone system was totally inadequate for the job. Kleinrock’s conviction of the need for packet switching was confirmed. In late 1966 Roberts went to DARPA to develop the computer network concept and quickly put together his plan for the “ARPANET”, publishing it in 1967. At the conference where he presented the paper, there was also a paper on a packet network concept from the UK by Donald Davies and Roger Scantlebury of NPL. Scantlebury told Roberts about the NPL work as well as that of Paul Baran and others at RAND. The RAND group had written a paper on packet switching networks for secure voice in the military in 1964. It happened that the work at MIT (1961-1967), at RAND (1962-1965), and at NPL (1964-1967) had all proceeded in parallel without any of the researchers knowing about the other work. The word “packet” was adopted from the work at NPL and the proposed line speed to be used in the ARPANET design was upgraded from 2.4 kbps to 50 kbps.5 In August 1968, after Roberts and the DARPA funded community had refined the overall structure and specifications for the ARPANET, an RFQ was released by DARPA for the development of one of the key components, the packet switches called Interface Message Processors (IMP’s). The RFQ was won in December 1968 by a group headed by Frank Heart at Bolt Beranek and Newman (BBN). As the BBN team worked on the IMP’s with Bob Kahn playing a major role in the overall ARPANET architectural design, the network topology and economics were designed and optimized by Roberts working with Howard Frank and his team at Network Analysis Corporation, and the network measurement system was prepared by Kleinrock’s team at UCLA.6 Due to Kleinrock’s early development of packet switching theory and his focus on analysis, design and measurement, his Network Measurement Center at UCLA was selected to be the first node on the ARPANET. All this came together in September 1969 when BBN installed the first IMP at UCLA and the first host computer was connected. Doug Engelbart’s project on “Augmentation of Human Intellect” (which included NLS, an early hypertext system) at Stanford Research Institute (SRI) provided a second node. SRI supported the Network Information Center, led by Elizabeth (Jake) Feinler and including functions such as maintaining tables of host name to address mapping as well as a directory of the RFC’s. One month later, when SRI was connected to the ARPANET, the first host-to-host message was sent from Kleinrock’s laboratory to SRI. Two more nodes were added at UC Santa Barbara and University of Utah. These last two nodes incorporated application visualization projects, with Glen Culler and Burton Fried at UCSB investigating methods for display of mathematical functions using storage displays to deal with the problem of refresh over the net, and Robert Taylor and Ivan Sutherland at Utah investigating methods of 3-D representations over the net. Thus, by the end of 1969, four host computers were connected together into the initial ARPANET, and the budding Internet was off the ground. Even at this early stage, it should be noted that the networking research incorporated both work on the underlying network and work on how to utilize the network. This tradition continues to this day. Computers were added quickly to the ARPANET during the following years, and work proceeded on completing a functionally complete Host-to-Host protocol and other network software. In December 1970 the Network Working Group (NWG) working under S. Crocker finished the initial ARPANET Host-to-Host protocol, called the Network Control Protocol (NCP). As the ARPANET sites completed implementing NCP during the period 1971-1972, the network users finally could begin to develop applications. In October 1972, Kahn organized a large, very successful demonstration of the ARPANET at the International Computer Communication Conference (ICCC). This was the first public demonstration of this new network technology to the public. It was also in 1972 that the initial “hot” application, electronic mail, was introduced. In March Ray Tomlinson at BBN wrote the basic email message send and read software, motivated by the need of the ARPANET developers for an easy coordination mechanism. In July, Roberts expanded its utility by writing the first email utility program to list, selectively read, file, forward, and respond to messages. From there email took off as the largest network application for over a decade. This was a harbinger of the kind of activity we see on the World Wide Web today, namely, the enormous growth of all kinds of “people-to-people” traffic.
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You must only respond with information found in the text block. You must begin with an introduction paragraph and finish with a concluding paragraph. The body must only be bullet points.
EVIDENCE:
The first recorded description of the social interactions that could be enabled through networking was a series of memos written by J.C.R. Licklider of MIT in August 1962 discussing his “Galactic Network” concept. He envisioned a globally interconnected set of computers through which everyone could quickly access data and programs from any site. In spirit, the concept was very much like the Internet of today. Licklider was the first head of the computer research program at DARPA,4 starting in October 1962. While at DARPA he convinced his successors at DARPA, Ivan Sutherland, Bob Taylor, and MIT researcher Lawrence G. Roberts, of the importance of this networking concept. Leonard Kleinrock at MIT published the first paper on packet switching theory in July 1961 and the first book on the subject in 1964. Kleinrock convinced Roberts of the theoretical feasibility of communications using packets rather than circuits, which was a major step along the path towards computer networking. The other key step was to make the computers talk together. To explore this, in 1965 working with Thomas Merrill, Roberts connected the TX-2 computer in Mass. to the Q-32 in California with a low speed dial-up telephone line creating the first (however small) wide-area computer network ever built. The result of this experiment was the realization that the time-shared computers could work well together, running programs and retrieving data as necessary on the remote machine, but that the circuit switched telephone system was totally inadequate for the job. Kleinrock’s conviction of the need for packet switching was confirmed. In late 1966 Roberts went to DARPA to develop the computer network concept and quickly put together his plan for the “ARPANET”, publishing it in 1967. At the conference where he presented the paper, there was also a paper on a packet network concept from the UK by Donald Davies and Roger Scantlebury of NPL. Scantlebury told Roberts about the NPL work as well as that of Paul Baran and others at RAND. The RAND group had written a paper on packet switching networks for secure voice in the military in 1964. It happened that the work at MIT (1961-1967), at RAND (1962-1965), and at NPL (1964-1967) had all proceeded in parallel without any of the researchers knowing about the other work. The word “packet” was adopted from the work at NPL and the proposed line speed to be used in the ARPANET design was upgraded from 2.4 kbps to 50 kbps.5 In August 1968, after Roberts and the DARPA funded community had refined the overall structure and specifications for the ARPANET, an RFQ was released by DARPA for the development of one of the key components, the packet switches called Interface Message Processors (IMP’s). The RFQ was won in December 1968 by a group headed by Frank Heart at Bolt Beranek and Newman (BBN). As the BBN team worked on the IMP’s with Bob Kahn playing a major role in the overall ARPANET architectural design, the network topology and economics were designed and optimized by Roberts working with Howard Frank and his team at Network Analysis Corporation, and the network measurement system was prepared by Kleinrock’s team at UCLA.6 Due to Kleinrock’s early development of packet switching theory and his focus on analysis, design and measurement, his Network Measurement Center at UCLA was selected to be the first node on the ARPANET. All this came together in September 1969 when BBN installed the first IMP at UCLA and the first host computer was connected. Doug Engelbart’s project on “Augmentation of Human Intellect” (which included NLS, an early hypertext system) at Stanford Research Institute (SRI) provided a second node. SRI supported the Network Information Center, led by Elizabeth (Jake) Feinler and including functions such as maintaining tables of host name to address mapping as well as a directory of the RFC’s. One month later, when SRI was connected to the ARPANET, the first host-to-host message was sent from Kleinrock’s laboratory to SRI. Two more nodes were added at UC Santa Barbara and University of Utah. These last two nodes incorporated application visualization projects, with Glen Culler and Burton Fried at UCSB investigating methods for display of mathematical functions using storage displays to deal with the problem of refresh over the net, and Robert Taylor and Ivan Sutherland at Utah investigating methods of 3-D representations over the net. Thus, by the end of 1969, four host computers were connected together into the initial ARPANET, and the budding Internet was off the ground. Even at this early stage, it should be noted that the networking research incorporated both work on the underlying network and work on how to utilize the network. This tradition continues to this day. Computers were added quickly to the ARPANET during the following years, and work proceeded on completing a functionally complete Host-to-Host protocol and other network software. In December 1970 the Network Working Group (NWG) working under S. Crocker finished the initial ARPANET Host-to-Host protocol, called the Network Control Protocol (NCP). As the ARPANET sites completed implementing NCP during the period 1971-1972, the network users finally could begin to develop applications. In October 1972, Kahn organized a large, very successful demonstration of the ARPANET at the International Computer Communication Conference (ICCC). This was the first public demonstration of this new network technology to the public. It was also in 1972 that the initial “hot” application, electronic mail, was introduced. In March Ray Tomlinson at BBN wrote the basic email message send and read software, motivated by the need of the ARPANET developers for an easy coordination mechanism. In July, Roberts expanded its utility by writing the first email utility program to list, selectively read, file, forward, and respond to messages. From there email took off as the largest network application for over a decade. This was a harbinger of the kind of activity we see on the World Wide Web today, namely, the enormous growth of all kinds of “people-to-people” traffic.
USER:
Can you provide a summary of the text, focusing on Lawrence G. Roberts' and Leonard Kleinrock's contributions to the origin of the internet?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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How do companies in the context of multi-cloud initiatives strike a balance between the demands of improved data security and cost minimization and the difficulties of handling growing complexity and possible interoperability issues? Talk about how these approaches help IT infrastructure be innovative and flexible, while also meeting the increasing needs for sustainability and integrating new technologies like edge computing, AI, and the IoT.
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Multi-cloud strategies are becoming popular as businesses look to improve data management, cost efficiency, and operational flexibility. This approach involves using cloud services from different providers to meet various needs, avoiding reliance on a single vendor. As more organizations undergo digital transformation, understanding the benefits and challenges of multi-cloud strategies becomes crucial for making informed decisions. The multi-cloud approach offers many advantages, such as improved resilience, cost optimization, and enhanced data security. However, it also presents challenges, including management complexity and potential interoperability issues. This blog explores the rise of multi-cloud strategies, highlighting the benefits and challenges they bring to businesses. What Makes Multi-Cloud Unique Multi-cloud strategies are unique because they leverage the strengths of various cloud providers. Is superior to single-cloud or hybrid cloud. It allows businesses to select the top services from various vendors. This ensures they receive the most suitable solutions for their requirements. This flexibility leads to improved performance and cost savings, as companies can optimize their resources more effectively. Another unique aspect of multi-cloud strategies is the enhanced resilience they offer. By spreading workloads across multiple cloud environments, businesses can minimize the risk of downtime and data loss. This distribution of resources ensures that if one cloud provider experiences an outage, the impact on overall operations is minimal, thus maintaining business continuity. Additionally, multi-cloud strategies provide greater freedom in vendor choice and negotiation power. Companies can switch vendors or services easily without causing major disruptions. This is because they are not limited to just one provider. This flexibility fosters innovation and adaptability, essential for staying competitive in today's fast-paced business environment. Essential Market for Business Businesses need to use multi-cloud strategies to stay competitive in the IT infrastructure market. One primary reason is the ability to manage large volumes of data more efficiently. With the rise of big data and analytics, businesses require robust and scalable solutions to handle their data needs. Multi-cloud strategies enable organizations to distribute data across different platforms, ensuring optimal performance and storage efficiency. Cost implications also play a significant role in the growing popularity of multi-cloud strategies. Businesses can save money and customize their cloud usage by using multiple cloud providers. This approach allows companies to avoid vendor lock-in and negotiate better deals, ultimately reducing overall IT costs. Flexibility is another critical factor driving the adoption of multi-cloud strategies. Businesses have many options for services and technologies to quickly adjust to market changes. Being adaptable is important for companies to innovate and grow. It allows them to try out different tools and solutions without being limited to just one vendor. Benefits of Multi-Cloud Strategies One of the most significant benefits of multi-cloud strategies is improved data management. By utilizing multiple cloud providers, businesses can distribute their data more efficiently, ensuring better performance and availability. This method helps with better disaster recovery and backup options by copying data to various cloud platforms. Cost savings are another major advantage of multi-cloud strategies. Companies can optimize their spending by selecting the most cost-effective services from various providers. This method helps businesses save money on cloud services and make sure they get the most out of their investment. Enhanced security is also a key benefit of multi-cloud strategies. With data spread across multiple cloud environments, businesses can implement robust security measures tailored to each platform. This multi-layered approach reduces the risk of data breaches and ensures protection of sensitive information. Challenges of Adopting Multi-Cloud Strategies Despite the numerous benefits, adopting a multi-cloud strategy comes with its challenges. One primary concern is the complexity of managing multiple cloud environments. Businesses need to invest in tools and expertise to ensure seamless integration and operation of various cloud services. This complexity can lead to increased operational costs and require specialized skills to manage effectively. Interoperability issues are another challenge associated with multi-cloud strategies. Cloud providers use various technologies and standards. This can make it difficult to integrate and manage workloads across different platforms. Businesses need to carefully plan their multi-cloud architecture to ensure compatibility and avoid potential conflicts. Additionally, data governance and compliance can become more challenging in a multi-cloud environment. Businesses need to make sure they follow rules and keep control of their data when using multiple cloud providers. This often involves implementing robust monitoring and auditing processes to ensure compliance. Strategic Advantages of Multi-Cloud Adopting a multi-cloud strategy provides businesses with several strategic advantages. One of the most notable is the ability to avoid vendor lock-in. Companies can use more than one cloud provider to switch services and providers easily when necessary. This allows them to avoid being limited to just one vendor. This flexibility enables companies to adapt to changing needs and take advantage of the best services available. This flexibility allows businesses to adapt quickly to market changes and take advantage of new technologies. Another strategic advantage is the ability to optimize performance. Multi-cloud strategies enable businesses to choose the best services for specific workloads, ensuring optimal performance and efficiency. This tailored approach helps companies meet their performance goals and deliver better customer experiences. Furthermore, multi-cloud strategies support innovation by providing access to a wide range of technologies and services. Businesses can experiment with new tools and solutions without being constrained by a single vendor's offerings. This freedom fosters creativity and innovation, helping companies stay competitive and drive growth. Current Trends and Industry Developments The rise of multi-cloud strategies is driven by several current trends and industry developments. One significant trend is the increasing demand for cloud-native applications. These applications are designed to run on multiple cloud environments, making them ideal for multi-cloud strategies. Businesses are adopting cloud-native technologies to improve scalability, performance, and resilience. Another trend is the growing importance of edge computing. With data being generated closer to the source, businesses need to process and analyze data at the edge of the network. Multi-cloud strategies enable organizations to leverage edge computing capabilities from different providers, ensuring they can meet the demands of real-time data processing. The adoption of artificial intelligence (AI) and machine learning (ML) is also driving the rise of multi-cloud strategies. These technologies require significant computing power and data storage, which can be efficiently managed using multiple cloud environments. Businesses are leveraging AI and ML to gain insights, automate processes, and improve decision-making. Future Developments and Opportunities As multi-cloud strategies continue to evolve, several future developments and opportunities are emerging. One area of growth is the development of advanced management tools. These tools will help businesses manage their multi-cloud environments more effectively, providing better visibility, control, and automation. Another area of opportunity is the integration of multi-cloud strategies with emerging technologies such as the Internet of Things (IoT) and 5G. These technologies will generate vast amounts of data that need to be processed and analyzed in real-time. Multi-cloud strategies will enable businesses to leverage the capabilities of different cloud providers to meet these demands. Additionally, the focus on sustainability is driving the adoption of multi-cloud strategies. Businesses are seeking to reduce their environmental impact by optimizing their cloud usage. Multi-cloud strategies allow organizations to choose eco-friendly cloud providers and implement energy-efficient practices, contributing to sustainability goals. The rise of multi-cloud strategies represents a significant shift in how businesses approach their IT infrastructure. By leveraging the strengths of multiple cloud providers, companies can improve data management, optimize costs, and enhance flexibility. However, adopting a multi-cloud approach also presents challenges, such as increased complexity and potential interoperability issues. As businesses continue to embrace digital transformation, understanding the benefits and challenges of multi-cloud strategies is crucial. By carefully planning and managing their multi-cloud environments, organizations can unlock new opportunities for innovation, growth, and sustainability. The future of multi-cloud strategies looks promising, with ongoing developments and emerging technologies set to drive further advancements in this dynamic field.
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[question] How do companies in the context of multi-cloud initiatives strike a balance between the demands of improved data security and cost minimization and the difficulties of handling growing complexity and possible interoperability issues? Talk about how these approaches help IT infrastructure be innovative and flexible, while also meeting the increasing needs for sustainability and integrating new technologies like edge computing, AI, and the IoT. ===================== [text] Multi-cloud strategies are becoming popular as businesses look to improve data management, cost efficiency, and operational flexibility. This approach involves using cloud services from different providers to meet various needs, avoiding reliance on a single vendor. As more organizations undergo digital transformation, understanding the benefits and challenges of multi-cloud strategies becomes crucial for making informed decisions. The multi-cloud approach offers many advantages, such as improved resilience, cost optimization, and enhanced data security. However, it also presents challenges, including management complexity and potential interoperability issues. This blog explores the rise of multi-cloud strategies, highlighting the benefits and challenges they bring to businesses. What Makes Multi-Cloud Unique Multi-cloud strategies are unique because they leverage the strengths of various cloud providers. Is superior to single-cloud or hybrid cloud. It allows businesses to select the top services from various vendors. This ensures they receive the most suitable solutions for their requirements. This flexibility leads to improved performance and cost savings, as companies can optimize their resources more effectively. Another unique aspect of multi-cloud strategies is the enhanced resilience they offer. By spreading workloads across multiple cloud environments, businesses can minimize the risk of downtime and data loss. This distribution of resources ensures that if one cloud provider experiences an outage, the impact on overall operations is minimal, thus maintaining business continuity. Additionally, multi-cloud strategies provide greater freedom in vendor choice and negotiation power. Companies can switch vendors or services easily without causing major disruptions. This is because they are not limited to just one provider. This flexibility fosters innovation and adaptability, essential for staying competitive in today's fast-paced business environment. Essential Market for Business Businesses need to use multi-cloud strategies to stay competitive in the IT infrastructure market. One primary reason is the ability to manage large volumes of data more efficiently. With the rise of big data and analytics, businesses require robust and scalable solutions to handle their data needs. Multi-cloud strategies enable organizations to distribute data across different platforms, ensuring optimal performance and storage efficiency. Cost implications also play a significant role in the growing popularity of multi-cloud strategies. Businesses can save money and customize their cloud usage by using multiple cloud providers. This approach allows companies to avoid vendor lock-in and negotiate better deals, ultimately reducing overall IT costs. Flexibility is another critical factor driving the adoption of multi-cloud strategies. Businesses have many options for services and technologies to quickly adjust to market changes. Being adaptable is important for companies to innovate and grow. It allows them to try out different tools and solutions without being limited to just one vendor. Benefits of Multi-Cloud Strategies One of the most significant benefits of multi-cloud strategies is improved data management. By utilizing multiple cloud providers, businesses can distribute their data more efficiently, ensuring better performance and availability. This method helps with better disaster recovery and backup options by copying data to various cloud platforms. Cost savings are another major advantage of multi-cloud strategies. Companies can optimize their spending by selecting the most cost-effective services from various providers. This method helps businesses save money on cloud services and make sure they get the most out of their investment. Enhanced security is also a key benefit of multi-cloud strategies. With data spread across multiple cloud environments, businesses can implement robust security measures tailored to each platform. This multi-layered approach reduces the risk of data breaches and ensures protection of sensitive information. Challenges of Adopting Multi-Cloud Strategies Despite the numerous benefits, adopting a multi-cloud strategy comes with its challenges. One primary concern is the complexity of managing multiple cloud environments. Businesses need to invest in tools and expertise to ensure seamless integration and operation of various cloud services. This complexity can lead to increased operational costs and require specialized skills to manage effectively. Interoperability issues are another challenge associated with multi-cloud strategies. Cloud providers use various technologies and standards. This can make it difficult to integrate and manage workloads across different platforms. Businesses need to carefully plan their multi-cloud architecture to ensure compatibility and avoid potential conflicts. Additionally, data governance and compliance can become more challenging in a multi-cloud environment. Businesses need to make sure they follow rules and keep control of their data when using multiple cloud providers. This often involves implementing robust monitoring and auditing processes to ensure compliance. Strategic Advantages of Multi-Cloud Adopting a multi-cloud strategy provides businesses with several strategic advantages. One of the most notable is the ability to avoid vendor lock-in. Companies can use more than one cloud provider to switch services and providers easily when necessary. This allows them to avoid being limited to just one vendor. This flexibility enables companies to adapt to changing needs and take advantage of the best services available. This flexibility allows businesses to adapt quickly to market changes and take advantage of new technologies. Another strategic advantage is the ability to optimize performance. Multi-cloud strategies enable businesses to choose the best services for specific workloads, ensuring optimal performance and efficiency. This tailored approach helps companies meet their performance goals and deliver better customer experiences. Furthermore, multi-cloud strategies support innovation by providing access to a wide range of technologies and services. Businesses can experiment with new tools and solutions without being constrained by a single vendor's offerings. This freedom fosters creativity and innovation, helping companies stay competitive and drive growth. Current Trends and Industry Developments The rise of multi-cloud strategies is driven by several current trends and industry developments. One significant trend is the increasing demand for cloud-native applications. These applications are designed to run on multiple cloud environments, making them ideal for multi-cloud strategies. Businesses are adopting cloud-native technologies to improve scalability, performance, and resilience. Another trend is the growing importance of edge computing. With data being generated closer to the source, businesses need to process and analyze data at the edge of the network. Multi-cloud strategies enable organizations to leverage edge computing capabilities from different providers, ensuring they can meet the demands of real-time data processing. The adoption of artificial intelligence (AI) and machine learning (ML) is also driving the rise of multi-cloud strategies. These technologies require significant computing power and data storage, which can be efficiently managed using multiple cloud environments. Businesses are leveraging AI and ML to gain insights, automate processes, and improve decision-making. Future Developments and Opportunities As multi-cloud strategies continue to evolve, several future developments and opportunities are emerging. One area of growth is the development of advanced management tools. These tools will help businesses manage their multi-cloud environments more effectively, providing better visibility, control, and automation. Another area of opportunity is the integration of multi-cloud strategies with emerging technologies such as the Internet of Things (IoT) and 5G. These technologies will generate vast amounts of data that need to be processed and analyzed in real-time. Multi-cloud strategies will enable businesses to leverage the capabilities of different cloud providers to meet these demands. Additionally, the focus on sustainability is driving the adoption of multi-cloud strategies. Businesses are seeking to reduce their environmental impact by optimizing their cloud usage. Multi-cloud strategies allow organizations to choose eco-friendly cloud providers and implement energy-efficient practices, contributing to sustainability goals. The rise of multi-cloud strategies represents a significant shift in how businesses approach their IT infrastructure. By leveraging the strengths of multiple cloud providers, companies can improve data management, optimize costs, and enhance flexibility. However, adopting a multi-cloud approach also presents challenges, such as increased complexity and potential interoperability issues. As businesses continue to embrace digital transformation, understanding the benefits and challenges of multi-cloud strategies is crucial. By carefully planning and managing their multi-cloud environments, organizations can unlock new opportunities for innovation, growth, and sustainability. The future of multi-cloud strategies looks promising, with ongoing developments and emerging technologies set to drive further advancements in this dynamic field. https://www.datacenters.com/news/the-rise-of-multi-cloud-strategies-exploring-the-benefits-and-challenges#:~:text=Multi%2Dcloud%20strategies%20are%20becoming,reliance%20on%20a%20single%20vendor. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
Multi-cloud strategies are becoming popular as businesses look to improve data management, cost efficiency, and operational flexibility. This approach involves using cloud services from different providers to meet various needs, avoiding reliance on a single vendor. As more organizations undergo digital transformation, understanding the benefits and challenges of multi-cloud strategies becomes crucial for making informed decisions. The multi-cloud approach offers many advantages, such as improved resilience, cost optimization, and enhanced data security. However, it also presents challenges, including management complexity and potential interoperability issues. This blog explores the rise of multi-cloud strategies, highlighting the benefits and challenges they bring to businesses. What Makes Multi-Cloud Unique Multi-cloud strategies are unique because they leverage the strengths of various cloud providers. Is superior to single-cloud or hybrid cloud. It allows businesses to select the top services from various vendors. This ensures they receive the most suitable solutions for their requirements. This flexibility leads to improved performance and cost savings, as companies can optimize their resources more effectively. Another unique aspect of multi-cloud strategies is the enhanced resilience they offer. By spreading workloads across multiple cloud environments, businesses can minimize the risk of downtime and data loss. This distribution of resources ensures that if one cloud provider experiences an outage, the impact on overall operations is minimal, thus maintaining business continuity. Additionally, multi-cloud strategies provide greater freedom in vendor choice and negotiation power. Companies can switch vendors or services easily without causing major disruptions. This is because they are not limited to just one provider. This flexibility fosters innovation and adaptability, essential for staying competitive in today's fast-paced business environment. Essential Market for Business Businesses need to use multi-cloud strategies to stay competitive in the IT infrastructure market. One primary reason is the ability to manage large volumes of data more efficiently. With the rise of big data and analytics, businesses require robust and scalable solutions to handle their data needs. Multi-cloud strategies enable organizations to distribute data across different platforms, ensuring optimal performance and storage efficiency. Cost implications also play a significant role in the growing popularity of multi-cloud strategies. Businesses can save money and customize their cloud usage by using multiple cloud providers. This approach allows companies to avoid vendor lock-in and negotiate better deals, ultimately reducing overall IT costs. Flexibility is another critical factor driving the adoption of multi-cloud strategies. Businesses have many options for services and technologies to quickly adjust to market changes. Being adaptable is important for companies to innovate and grow. It allows them to try out different tools and solutions without being limited to just one vendor. Benefits of Multi-Cloud Strategies One of the most significant benefits of multi-cloud strategies is improved data management. By utilizing multiple cloud providers, businesses can distribute their data more efficiently, ensuring better performance and availability. This method helps with better disaster recovery and backup options by copying data to various cloud platforms. Cost savings are another major advantage of multi-cloud strategies. Companies can optimize their spending by selecting the most cost-effective services from various providers. This method helps businesses save money on cloud services and make sure they get the most out of their investment. Enhanced security is also a key benefit of multi-cloud strategies. With data spread across multiple cloud environments, businesses can implement robust security measures tailored to each platform. This multi-layered approach reduces the risk of data breaches and ensures protection of sensitive information. Challenges of Adopting Multi-Cloud Strategies Despite the numerous benefits, adopting a multi-cloud strategy comes with its challenges. One primary concern is the complexity of managing multiple cloud environments. Businesses need to invest in tools and expertise to ensure seamless integration and operation of various cloud services. This complexity can lead to increased operational costs and require specialized skills to manage effectively. Interoperability issues are another challenge associated with multi-cloud strategies. Cloud providers use various technologies and standards. This can make it difficult to integrate and manage workloads across different platforms. Businesses need to carefully plan their multi-cloud architecture to ensure compatibility and avoid potential conflicts. Additionally, data governance and compliance can become more challenging in a multi-cloud environment. Businesses need to make sure they follow rules and keep control of their data when using multiple cloud providers. This often involves implementing robust monitoring and auditing processes to ensure compliance. Strategic Advantages of Multi-Cloud Adopting a multi-cloud strategy provides businesses with several strategic advantages. One of the most notable is the ability to avoid vendor lock-in. Companies can use more than one cloud provider to switch services and providers easily when necessary. This allows them to avoid being limited to just one vendor. This flexibility enables companies to adapt to changing needs and take advantage of the best services available. This flexibility allows businesses to adapt quickly to market changes and take advantage of new technologies. Another strategic advantage is the ability to optimize performance. Multi-cloud strategies enable businesses to choose the best services for specific workloads, ensuring optimal performance and efficiency. This tailored approach helps companies meet their performance goals and deliver better customer experiences. Furthermore, multi-cloud strategies support innovation by providing access to a wide range of technologies and services. Businesses can experiment with new tools and solutions without being constrained by a single vendor's offerings. This freedom fosters creativity and innovation, helping companies stay competitive and drive growth. Current Trends and Industry Developments The rise of multi-cloud strategies is driven by several current trends and industry developments. One significant trend is the increasing demand for cloud-native applications. These applications are designed to run on multiple cloud environments, making them ideal for multi-cloud strategies. Businesses are adopting cloud-native technologies to improve scalability, performance, and resilience. Another trend is the growing importance of edge computing. With data being generated closer to the source, businesses need to process and analyze data at the edge of the network. Multi-cloud strategies enable organizations to leverage edge computing capabilities from different providers, ensuring they can meet the demands of real-time data processing. The adoption of artificial intelligence (AI) and machine learning (ML) is also driving the rise of multi-cloud strategies. These technologies require significant computing power and data storage, which can be efficiently managed using multiple cloud environments. Businesses are leveraging AI and ML to gain insights, automate processes, and improve decision-making. Future Developments and Opportunities As multi-cloud strategies continue to evolve, several future developments and opportunities are emerging. One area of growth is the development of advanced management tools. These tools will help businesses manage their multi-cloud environments more effectively, providing better visibility, control, and automation. Another area of opportunity is the integration of multi-cloud strategies with emerging technologies such as the Internet of Things (IoT) and 5G. These technologies will generate vast amounts of data that need to be processed and analyzed in real-time. Multi-cloud strategies will enable businesses to leverage the capabilities of different cloud providers to meet these demands. Additionally, the focus on sustainability is driving the adoption of multi-cloud strategies. Businesses are seeking to reduce their environmental impact by optimizing their cloud usage. Multi-cloud strategies allow organizations to choose eco-friendly cloud providers and implement energy-efficient practices, contributing to sustainability goals. The rise of multi-cloud strategies represents a significant shift in how businesses approach their IT infrastructure. By leveraging the strengths of multiple cloud providers, companies can improve data management, optimize costs, and enhance flexibility. However, adopting a multi-cloud approach also presents challenges, such as increased complexity and potential interoperability issues. As businesses continue to embrace digital transformation, understanding the benefits and challenges of multi-cloud strategies is crucial. By carefully planning and managing their multi-cloud environments, organizations can unlock new opportunities for innovation, growth, and sustainability. The future of multi-cloud strategies looks promising, with ongoing developments and emerging technologies set to drive further advancements in this dynamic field.
USER:
How do companies in the context of multi-cloud initiatives strike a balance between the demands of improved data security and cost minimization and the difficulties of handling growing complexity and possible interoperability issues? Talk about how these approaches help IT infrastructure be innovative and flexible, while also meeting the increasing needs for sustainability and integrating new technologies like edge computing, AI, and the IoT.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 64 | 1,294 | null | 738 |
Answer using only the information provided below. Include a quote from the text to support each point.
|
What are the pros and cons of the Supreme Court having a Code of Conduct?
|
Ethics and the Supreme Court By its explicit terms, the Code governs only the judges of the lower federal courts. It does not apply to Supreme Court Justices, nor has the Supreme Court formally promulgated its own ethical code. As a result, there is presently no single body of ethical canons with which the nation’s highest court must comply when discharging its judicial duties. The absence of such a body of canons does not mean that Supreme Court Justices are wholly unconstrained by ethical norms and guidelines. Even though the Code does not formally apply to Supreme Court Justices, the Justices “consult the Code of Conduct” and other authorities “to resolve specific ethical issues.” Moreover, although Congress has not enacted legislation mandating the adoption of a Supreme Court code of conduct, several statutes do impose various other ethical requirements upon the Justices. For example, 28 U.S.C. § 455 requires federal judges, including Supreme Court Justices, to recuse themselves from particular cases under specified circumstances, such as when the judge or Justice “has a personal bias or prejudice concerning a party” or “a financial interest in the subject matter in controversy.” Congress has also directed Supreme Court Justices to comply with certain financial disclosure requirements that apply to federal officials generally. In addition, the Court has voluntarily resolved to comply with certain Judicial Conference regulations pertaining to the receipt of gifts by judicial officers, even though those regulations would otherwise not apply to Supreme Court Justices. In response to calls to mandate a code of ethics for the Supreme Court, some Members of the 117th Congress introduced the For the People Act of 2021 (H.R. 1/S. 1), which, among other things, would require “the Judicial Conference [to] issue a code of conduct, which applies to each justice … of the United States.” The Supreme Court Ethics Act (H.R. 4766/S. 2512) would impose the same requirement through standalone legislation. These proposals echo similar bills from past Congresses that would have likewise subjected the Supreme Court to a code of judicial conduct. Legal Considerations for Congress Legislative proposals to impose a code of conduct on the Supreme Court raise an array of legal questions. The first is a question of statutory design: Which institution would Congress charge with formulating the ethical standards to govern the Justices? A legislative proposal introduced in the 115th Congress would have entrusted the Supreme Court itself with the task of “promulgat[ing] a code of ethics” and would have given the Justices substantial (albeit not unbounded) freedom to design the rules that would govern their own conduct. Similarly, a House resolution introduced during the 117th Congress would express “the sense of the House of Representatives that the Justices of the Supreme Court should make themselves subject to the existing and operative ethics guidelines set out in the Code of Conduct for United States Judges, or should promulgate their own code of conduct.” The For the People Act and the Supreme Court Ethics Act, by contrast, would not allow the Court to design its own ethical code; those proposals would instead grant that authority to the Judicial Conference. A related question is whether legislative efforts to require the Supreme Court to abide by a code of judicial conduct would violate the constitutional separation of powers. To ensure that federal judges would decide cases impartially without fear of political retaliation, the Framers of the Constitution purposefully insulated the federal judiciary from political control. Chief Justice John Roberts invoked those ideals in his 2021 Year-End Report on the Federal Judiciary, asserting that the courts “require ample institutional independence” and that “[t]he Judiciary’s power to manage its internal affairs insulates courts from inappropriate political influence and is crucial to preserving public trust in its work as a separate and coequal branch of government.” Some observers have argued that imposing a code of conduct upon the Supreme Court would amount to an unconstitutional legislative usurpation of judicial authority. The House resolution discussed above notes that separation of powers and the independence of the judiciary “may be compromised by extensive legislative or executive interference into that branch’s functions” and would thus avoid imposing any binding requirement on the Court. On the other hand, some commentators emphasize the ways that Congress may validly act with respect to the Supreme Court, for example through its authority to impeach Justices and decide whether Justices are entitled to salary increases. By extension, according to this argument, requiring the Supreme Court to adopt a code of conduct would constitute a permissible exercise of Congress’s authority. Because the Supreme Court possesses the authority to determine the constitutionality of legislative enactments, the Supreme Court itself would appear to have a critical role in determining whether Congress may validly impose a code of ethical conduct upon it. It is difficult to predict whether the Court would uphold the constitutionality of a legislatively mandated code of conduct, as existing judicial precedent offers minimal guidance on how the Court might resolve this constitutional question. For instance, the Supreme Court has never explicitly decided whether the federal statute requiring Supreme Court Justices to recuse themselves from particular cases is an unconstitutional legislative encroachment upon the judiciary, nor has the Court ever directly addressed whether Congress may subject Supreme Court Justices to financial reporting requirements or limitations upon the receipt of gifts. Distinct from this separation-of-powers issue is the question of whether Congress may authorize the Judicial Conference—which is composed almost entirely of judges from the inferior federal courts—to promulgate ethical rules to govern Justices on the High Court. The Constitution explicitly contemplates that the Supreme Court will remain “supreme” over any “inferior” courts that “Congress may from time to time ordain and establish,” such as the federal district and appellate courts. Some observers have therefore suggested that it would be unconstitutional, or at least inappropriate, for the Judicial Conference to make rules for the Supreme Court. As one example, Senior Associate Justice Anthony Kennedy has stated that it would raise a “legal problem” and would be “structurally unprecedented for district and circuit judges to make rules that Supreme Court judges have to follow.” A Supreme Court code of conduct could also raise practical issues to the extent that it would require Justices to disqualify themselves from particular cases. Unlike in the lower courts, where a district or circuit judge from the same court may step in to take a recused judge’s place, neither retired Justices of the Supreme Court nor lower court judges may hear a case in a recused Justice’s stead. The disqualification of a Supreme Court Justice from a particular case could leave the Court with an even number of Justices to decide the case and thus increase the likelihood that the Court would be evenly divided and unable to create binding precedent for future litigants. Conversely, if the other Justices would otherwise be evenly divided, it may be even more critical for a Justice with an appearance of partiality to avoid casting the deciding vote. If one or more Justices refused or failed to comply with a newly created code of conduct, Congress might also encounter difficulties enforcing its tenets. The Constitution forbids Congress from reducing Supreme Court Justices’ salaries or removing them from office except via the extraordinary and blunt remedy of impeachment. Thus, Congress may lack precise tools to induce recalcitrant Justices to behave ethically. Ultimately, the foregoing questions related to a Supreme Court code of conduct may be largely academic. Promulgating an ethical code for the Supreme Court could establish norms for proper judicial behavior that guide the Justices’ actions. Thus, if Congress sought to compel the Supreme Court to comply with a code of judicial conduct, the Justices might simply comply with its mandates without challenging Congress’s constitutional authority to impose them. The Court has often acquiesced to congressional attempts to subject Justices to specific ethical standards. For example, when Congress decided to subject the Justices to financial disclosure requirements, the Justices opted to comply with those provisions rather than challenge their constitutionality in court. Justices have likewise implicitly accepted the validity of 28 U.S.C. § 455, discussed above, and recused themselves pursuant to that statute without questioning whether Congress possesses the constitutional authority to enact a judicial disqualification statute.
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Question: What are the pros and cons of the Supreme Court having a Code of Conduct? System Instruction: Answer using only the information provided below. Include a quote from the text to support each point. Context: Ethics and the Supreme Court By its explicit terms, the Code governs only the judges of the lower federal courts. It does not apply to Supreme Court Justices, nor has the Supreme Court formally promulgated its own ethical code. As a result, there is presently no single body of ethical canons with which the nation’s highest court must comply when discharging its judicial duties. The absence of such a body of canons does not mean that Supreme Court Justices are wholly unconstrained by ethical norms and guidelines. Even though the Code does not formally apply to Supreme Court Justices, the Justices “consult the Code of Conduct” and other authorities “to resolve specific ethical issues.” Moreover, although Congress has not enacted legislation mandating the adoption of a Supreme Court code of conduct, several statutes do impose various other ethical requirements upon the Justices. For example, 28 U.S.C. § 455 requires federal judges, including Supreme Court Justices, to recuse themselves from particular cases under specified circumstances, such as when the judge or Justice “has a personal bias or prejudice concerning a party” or “a financial interest in the subject matter in controversy.” Congress has also directed Supreme Court Justices to comply with certain financial disclosure requirements that apply to federal officials generally. In addition, the Court has voluntarily resolved to comply with certain Judicial Conference regulations pertaining to the receipt of gifts by judicial officers, even though those regulations would otherwise not apply to Supreme Court Justices. In response to calls to mandate a code of ethics for the Supreme Court, some Members of the 117th Congress introduced the For the People Act of 2021 (H.R. 1/S. 1), which, among other things, would require “the Judicial Conference [to] issue a code of conduct, which applies to each justice … of the United States.” The Supreme Court Ethics Act (H.R. 4766/S. 2512) would impose the same requirement through standalone legislation. These proposals echo similar bills from past Congresses that would have likewise subjected the Supreme Court to a code of judicial conduct. Legal Considerations for Congress Legislative proposals to impose a code of conduct on the Supreme Court raise an array of legal questions. The first is a question of statutory design: Which institution would Congress charge with formulating the ethical standards to govern the Justices? A legislative proposal introduced in the 115th Congress would have entrusted the Supreme Court itself with the task of “promulgat[ing] a code of ethics” and would have given the Justices substantial (albeit not unbounded) freedom to design the rules that would govern their own conduct. Similarly, a House resolution introduced during the 117th Congress would express “the sense of the House of Representatives that the Justices of the Supreme Court should make themselves subject to the existing and operative ethics guidelines set out in the Code of Conduct for United States Judges, or should promulgate their own code of conduct.” The For the People Act and the Supreme Court Ethics Act, by contrast, would not allow the Court to design its own ethical code; those proposals would instead grant that authority to the Judicial Conference. A related question is whether legislative efforts to require the Supreme Court to abide by a code of judicial conduct would violate the constitutional separation of powers. To ensure that federal judges would decide cases impartially without fear of political retaliation, the Framers of the Constitution purposefully insulated the federal judiciary from political control. Chief Justice John Roberts invoked those ideals in his 2021 Year-End Report on the Federal Judiciary, asserting that the courts “require ample institutional independence” and that “[t]he Judiciary’s power to manage its internal affairs insulates courts from inappropriate political influence and is crucial to preserving public trust in its work as a separate and coequal branch of government.” Some observers have argued that imposing a code of conduct upon the Supreme Court would amount to an unconstitutional legislative usurpation of judicial authority. The House resolution discussed above notes that separation of powers and the independence of the judiciary “may be compromised by extensive legislative or executive interference into that branch’s functions” and would thus avoid imposing any binding requirement on the Court. On the other hand, some commentators emphasize the ways that Congress may validly act with respect to the Supreme Court, for example through its authority to impeach Justices and decide whether Justices are entitled to salary increases. By extension, according to this argument, requiring the Supreme Court to adopt a code of conduct would constitute a permissible exercise of Congress’s authority. Because the Supreme Court possesses the authority to determine the constitutionality of legislative enactments, the Supreme Court itself would appear to have a critical role in determining whether Congress may validly impose a code of ethical conduct upon it. It is difficult to predict whether the Court would uphold the constitutionality of a legislatively mandated code of conduct, as existing judicial precedent offers minimal guidance on how the Court might resolve this constitutional question. For instance, the Supreme Court has never explicitly decided whether the federal statute requiring Supreme Court Justices to recuse themselves from particular cases is an unconstitutional legislative encroachment upon the judiciary, nor has the Court ever directly addressed whether Congress may subject Supreme Court Justices to financial reporting requirements or limitations upon the receipt of gifts. Distinct from this separation-of-powers issue is the question of whether Congress may authorize the Judicial Conference—which is composed almost entirely of judges from the inferior federal courts—to promulgate ethical rules to govern Justices on the High Court. The Constitution explicitly contemplates that the Supreme Court will remain “supreme” over any “inferior” courts that “Congress may from time to time ordain and establish,” such as the federal district and appellate courts. Some observers have therefore suggested that it would be unconstitutional, or at least inappropriate, for the Judicial Conference to make rules for the Supreme Court. As one example, Senior Associate Justice Anthony Kennedy has stated that it would raise a “legal problem” and would be “structurally unprecedented for district and circuit judges to make rules that Supreme Court judges have to follow.” A Supreme Court code of conduct could also raise practical issues to the extent that it would require Justices to disqualify themselves from particular cases. Unlike in the lower courts, where a district or circuit judge from the same court may step in to take a recused judge’s place, neither retired Justices of the Supreme Court nor lower court judges may hear a case in a recused Justice’s stead. The disqualification of a Supreme Court Justice from a particular case could leave the Court with an even number of Justices to decide the case and thus increase the likelihood that the Court would be evenly divided and unable to create binding precedent for future litigants. Conversely, if the other Justices would otherwise be evenly divided, it may be even more critical for a Justice with an appearance of partiality to avoid casting the deciding vote. If one or more Justices refused or failed to comply with a newly created code of conduct, Congress might also encounter difficulties enforcing its tenets. The Constitution forbids Congress from reducing Supreme Court Justices’ salaries or removing them from office except via the extraordinary and blunt remedy of impeachment. Thus, Congress may lack precise tools to induce recalcitrant Justices to behave ethically. Ultimately, the foregoing questions related to a Supreme Court code of conduct may be largely academic. Promulgating an ethical code for the Supreme Court could establish norms for proper judicial behavior that guide the Justices’ actions. Thus, if Congress sought to compel the Supreme Court to comply with a code of judicial conduct, the Justices might simply comply with its mandates without challenging Congress’s constitutional authority to impose them. The Court has often acquiesced to congressional attempts to subject Justices to specific ethical standards. For example, when Congress decided to subject the Justices to financial disclosure requirements, the Justices opted to comply with those provisions rather than challenge their constitutionality in court. Justices have likewise implicitly accepted the validity of 28 U.S.C. § 455, discussed above, and recused themselves pursuant to that statute without questioning whether Congress possesses the constitutional authority to enact a judicial disqualification statute.
|
Answer using only the information provided below. Include a quote from the text to support each point.
EVIDENCE:
Ethics and the Supreme Court By its explicit terms, the Code governs only the judges of the lower federal courts. It does not apply to Supreme Court Justices, nor has the Supreme Court formally promulgated its own ethical code. As a result, there is presently no single body of ethical canons with which the nation’s highest court must comply when discharging its judicial duties. The absence of such a body of canons does not mean that Supreme Court Justices are wholly unconstrained by ethical norms and guidelines. Even though the Code does not formally apply to Supreme Court Justices, the Justices “consult the Code of Conduct” and other authorities “to resolve specific ethical issues.” Moreover, although Congress has not enacted legislation mandating the adoption of a Supreme Court code of conduct, several statutes do impose various other ethical requirements upon the Justices. For example, 28 U.S.C. § 455 requires federal judges, including Supreme Court Justices, to recuse themselves from particular cases under specified circumstances, such as when the judge or Justice “has a personal bias or prejudice concerning a party” or “a financial interest in the subject matter in controversy.” Congress has also directed Supreme Court Justices to comply with certain financial disclosure requirements that apply to federal officials generally. In addition, the Court has voluntarily resolved to comply with certain Judicial Conference regulations pertaining to the receipt of gifts by judicial officers, even though those regulations would otherwise not apply to Supreme Court Justices. In response to calls to mandate a code of ethics for the Supreme Court, some Members of the 117th Congress introduced the For the People Act of 2021 (H.R. 1/S. 1), which, among other things, would require “the Judicial Conference [to] issue a code of conduct, which applies to each justice … of the United States.” The Supreme Court Ethics Act (H.R. 4766/S. 2512) would impose the same requirement through standalone legislation. These proposals echo similar bills from past Congresses that would have likewise subjected the Supreme Court to a code of judicial conduct. Legal Considerations for Congress Legislative proposals to impose a code of conduct on the Supreme Court raise an array of legal questions. The first is a question of statutory design: Which institution would Congress charge with formulating the ethical standards to govern the Justices? A legislative proposal introduced in the 115th Congress would have entrusted the Supreme Court itself with the task of “promulgat[ing] a code of ethics” and would have given the Justices substantial (albeit not unbounded) freedom to design the rules that would govern their own conduct. Similarly, a House resolution introduced during the 117th Congress would express “the sense of the House of Representatives that the Justices of the Supreme Court should make themselves subject to the existing and operative ethics guidelines set out in the Code of Conduct for United States Judges, or should promulgate their own code of conduct.” The For the People Act and the Supreme Court Ethics Act, by contrast, would not allow the Court to design its own ethical code; those proposals would instead grant that authority to the Judicial Conference. A related question is whether legislative efforts to require the Supreme Court to abide by a code of judicial conduct would violate the constitutional separation of powers. To ensure that federal judges would decide cases impartially without fear of political retaliation, the Framers of the Constitution purposefully insulated the federal judiciary from political control. Chief Justice John Roberts invoked those ideals in his 2021 Year-End Report on the Federal Judiciary, asserting that the courts “require ample institutional independence” and that “[t]he Judiciary’s power to manage its internal affairs insulates courts from inappropriate political influence and is crucial to preserving public trust in its work as a separate and coequal branch of government.” Some observers have argued that imposing a code of conduct upon the Supreme Court would amount to an unconstitutional legislative usurpation of judicial authority. The House resolution discussed above notes that separation of powers and the independence of the judiciary “may be compromised by extensive legislative or executive interference into that branch’s functions” and would thus avoid imposing any binding requirement on the Court. On the other hand, some commentators emphasize the ways that Congress may validly act with respect to the Supreme Court, for example through its authority to impeach Justices and decide whether Justices are entitled to salary increases. By extension, according to this argument, requiring the Supreme Court to adopt a code of conduct would constitute a permissible exercise of Congress’s authority. Because the Supreme Court possesses the authority to determine the constitutionality of legislative enactments, the Supreme Court itself would appear to have a critical role in determining whether Congress may validly impose a code of ethical conduct upon it. It is difficult to predict whether the Court would uphold the constitutionality of a legislatively mandated code of conduct, as existing judicial precedent offers minimal guidance on how the Court might resolve this constitutional question. For instance, the Supreme Court has never explicitly decided whether the federal statute requiring Supreme Court Justices to recuse themselves from particular cases is an unconstitutional legislative encroachment upon the judiciary, nor has the Court ever directly addressed whether Congress may subject Supreme Court Justices to financial reporting requirements or limitations upon the receipt of gifts. Distinct from this separation-of-powers issue is the question of whether Congress may authorize the Judicial Conference—which is composed almost entirely of judges from the inferior federal courts—to promulgate ethical rules to govern Justices on the High Court. The Constitution explicitly contemplates that the Supreme Court will remain “supreme” over any “inferior” courts that “Congress may from time to time ordain and establish,” such as the federal district and appellate courts. Some observers have therefore suggested that it would be unconstitutional, or at least inappropriate, for the Judicial Conference to make rules for the Supreme Court. As one example, Senior Associate Justice Anthony Kennedy has stated that it would raise a “legal problem” and would be “structurally unprecedented for district and circuit judges to make rules that Supreme Court judges have to follow.” A Supreme Court code of conduct could also raise practical issues to the extent that it would require Justices to disqualify themselves from particular cases. Unlike in the lower courts, where a district or circuit judge from the same court may step in to take a recused judge’s place, neither retired Justices of the Supreme Court nor lower court judges may hear a case in a recused Justice’s stead. The disqualification of a Supreme Court Justice from a particular case could leave the Court with an even number of Justices to decide the case and thus increase the likelihood that the Court would be evenly divided and unable to create binding precedent for future litigants. Conversely, if the other Justices would otherwise be evenly divided, it may be even more critical for a Justice with an appearance of partiality to avoid casting the deciding vote. If one or more Justices refused or failed to comply with a newly created code of conduct, Congress might also encounter difficulties enforcing its tenets. The Constitution forbids Congress from reducing Supreme Court Justices’ salaries or removing them from office except via the extraordinary and blunt remedy of impeachment. Thus, Congress may lack precise tools to induce recalcitrant Justices to behave ethically. Ultimately, the foregoing questions related to a Supreme Court code of conduct may be largely academic. Promulgating an ethical code for the Supreme Court could establish norms for proper judicial behavior that guide the Justices’ actions. Thus, if Congress sought to compel the Supreme Court to comply with a code of judicial conduct, the Justices might simply comply with its mandates without challenging Congress’s constitutional authority to impose them. The Court has often acquiesced to congressional attempts to subject Justices to specific ethical standards. For example, when Congress decided to subject the Justices to financial disclosure requirements, the Justices opted to comply with those provisions rather than challenge their constitutionality in court. Justices have likewise implicitly accepted the validity of 28 U.S.C. § 455, discussed above, and recused themselves pursuant to that statute without questioning whether Congress possesses the constitutional authority to enact a judicial disqualification statute.
USER:
What are the pros and cons of the Supreme Court having a Code of Conduct?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 17 | 15 | 1,371 | null | 551 |
Draw your answer from the text in this prompt and this prompt alone. Do not use outside information or external resources.
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Summarize how athletes can be tested for doping in the Olympic Games Paris 2024.
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The anti-doping rules for the Paris Games apply to “all Athletes entered in or preparing for the Olympic Games Paris 2024 or who have otherwise been made subject to the authority of the IOC in connection with the Olympic Games.” Additionally, a number of rules apply to other individuals, including coaches, trainers, and operations staff for the Games. Athletes seeking to qualify for and participating in the 2024 Olympic Games were subject to testing under IOC’s anti-doping policy beginning in April 2024 and will continue to be so through the close of the Games. IOC’s anti-doping rules are “in accordance” with the World Anti-Doping Code, which includes technical and procedural rules for the administration of anti-doping programs, the prohibited substances list, and standards for testing laboratories, among other things. In addition to testing and related requirements for athletes, other participants are barred from supporting doping, evasion of testing, and manipulation of test results. As signatories to the Code, IOC and IPC are each responsible for ensuring that their events are conducted in compliance with WADA’s anti-doping requirements. A principal component of that obligation is the collection of biological samples from athletes that can be tested for banned substances. While IPC administers its own testing program, IOC has delegated this responsibility to ITA for the 2024 Games. ITA is an independent organization created in 2018 by IOC and WADA to manage testing programs for international sports federations and major events. IOC’s anti-doping rules require athletes to submit to testing based on WADA’s International Standard for Testing and Investigations, which allows the collection of both blood and urine samples to test for prohibited substances. According to the organizers, the anti-doping program for the Paris Games will include over 1,000 workers and an “anti-doping control space” at each venue where ITA and AFLD will collect samples. Following collection, AFLD will test samples.
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System Instruction: Draw your answer from the text in this prompt and this prompt alone. Do not use outside information or external resources. Question: Summarize how athletes can be tested for doping in the Olympic Games Paris 2024. Context: The anti-doping rules for the Paris Games apply to “all Athletes entered in or preparing for the Olympic Games Paris 2024 or who have otherwise been made subject to the authority of the IOC in connection with the Olympic Games.” Additionally, a number of rules apply to other individuals, including coaches, trainers, and operations staff for the Games. Athletes seeking to qualify for and participating in the 2024 Olympic Games were subject to testing under IOC’s anti-doping policy beginning in April 2024 and will continue to be so through the close of the Games. IOC’s anti-doping rules are “in accordance” with the World Anti-Doping Code, which includes technical and procedural rules for the administration of anti-doping programs, the prohibited substances list, and standards for testing laboratories, among other things. In addition to testing and related requirements for athletes, other participants are barred from supporting doping, evasion of testing, and manipulation of test results. As signatories to the Code, IOC and IPC are each responsible for ensuring that their events are conducted in compliance with WADA’s anti-doping requirements. A principal component of that obligation is the collection of biological samples from athletes that can be tested for banned substances. While IPC administers its own testing program, IOC has delegated this responsibility to ITA for the 2024 Games. ITA is an independent organization created in 2018 by IOC and WADA to manage testing programs for international sports federations and major events. IOC’s anti-doping rules require athletes to submit to testing based on WADA’s International Standard for Testing and Investigations, which allows the collection of both blood and urine samples to test for prohibited substances. According to the organizers, the anti-doping program for the Paris Games will include over 1,000 workers and an “anti-doping control space” at each venue where ITA and AFLD will collect samples. Following collection, AFLD will test samples.
|
Draw your answer from the text in this prompt and this prompt alone. Do not use outside information or external resources.
EVIDENCE:
The anti-doping rules for the Paris Games apply to “all Athletes entered in or preparing for the Olympic Games Paris 2024 or who have otherwise been made subject to the authority of the IOC in connection with the Olympic Games.” Additionally, a number of rules apply to other individuals, including coaches, trainers, and operations staff for the Games. Athletes seeking to qualify for and participating in the 2024 Olympic Games were subject to testing under IOC’s anti-doping policy beginning in April 2024 and will continue to be so through the close of the Games. IOC’s anti-doping rules are “in accordance” with the World Anti-Doping Code, which includes technical and procedural rules for the administration of anti-doping programs, the prohibited substances list, and standards for testing laboratories, among other things. In addition to testing and related requirements for athletes, other participants are barred from supporting doping, evasion of testing, and manipulation of test results. As signatories to the Code, IOC and IPC are each responsible for ensuring that their events are conducted in compliance with WADA’s anti-doping requirements. A principal component of that obligation is the collection of biological samples from athletes that can be tested for banned substances. While IPC administers its own testing program, IOC has delegated this responsibility to ITA for the 2024 Games. ITA is an independent organization created in 2018 by IOC and WADA to manage testing programs for international sports federations and major events. IOC’s anti-doping rules require athletes to submit to testing based on WADA’s International Standard for Testing and Investigations, which allows the collection of both blood and urine samples to test for prohibited substances. According to the organizers, the anti-doping program for the Paris Games will include over 1,000 workers and an “anti-doping control space” at each venue where ITA and AFLD will collect samples. Following collection, AFLD will test samples.
USER:
Summarize how athletes can be tested for doping in the Olympic Games Paris 2024.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 21 | 14 | 309 | null | 213 |
Only use the information in the context document. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context".
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According to the context document only, how can APs profit from a Bitcoin ETF?
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**Spot Bitcoin ETFs: What Are They, And How Do They Work?** Bitcoin has been one of the best-performing assets over the last decade, rising from a relatively obscure peer-to-peer payment network to a global phenomenon. As the original cryptocurrency, bitcoin has spurred an entirely new asset class that now has over $1 trillion in market capitalization. With the approval of 11 spot bitcoin ETFs in January 2024, traditional investors have an even easier way to invest in bitcoin. What Is a Spot Bitcoin ETF? On January 10, 2024, the SEC approved 11 new spot bitcoin ETFs. ETFs, or exchange-traded funds, are a type of security that tracks the underlying performance of a collection of assets or commodities. A spot bitcoin ETF is an exchange-traded fund that tracks the spot, or current price of bitcoin. By holding an equivalent amount of bitcoin to back every share of the ETF that is sold, the fund is actually backed by bitcoin itself. Considering the hoops you have to jump through to own bitcoin—exchange accounts, digital wallets, private keys, network transfers, etc.—a spot bitcoin ETF is one of the easiest ways to add bitcoin exposure to your portfolio. Spot ETFs, such as the new spot bitcoin ETFs, allow for shares of the fund to be created or redeemed based on market demand. In this way, a spot bitcoin ETF allows investors to gain exposure to the current price of bitcoin without having to hold the asset itself. This is in contrast to bitcoin futures ETFs, which were approved for trading by the U.S. Securities and Exchange Commission in October 2021 and can only trade bitcoin futures. Futures are complex derivatives instruments that track potential future prices of the underlying asset. How Do Spot Bitcoin ETFs Work? Spot bitcoin ETFs purchase a select amount of bitcoins that are held in a secure digital wallet by a custodian. These custodians offer bitcoin storage in a secure vault. Most of these vaults are—as crypto insiders call—air gapped in “cold storage,” which means the bitcoins’ keys are stored offline and cannot be accessed through the internet. The ETFs then issue shares that represent the bitcoins held by the fund. These shares are priced to reflect the current spot price of bitcoin and can be traded on traditional stock exchanges. Spot bitcoin ETFs make it easier for retail investors and traders to buy and sell an asset tied to the current value of bitcoin without needing to hold bitcoin itself. They also allow investors seeking exposure to bitcoin in retirement accounts to have a much simpler option than opening a self-directed IRA that could hold bitcoin directly. How Does a Spot ETF Maintain Its Price? The price of a spot ETF can depart from the actual value of the underlying asset. To bring the fund back in line with the asset’s actual value, authorized participants, otherwise known as APs, are allowed to create or redeem large blocks of shares. APs are typically large financial institutions that profit from the arbitrage opportunity presented when an ETF’s price is higher or lower than the underlying asset’s value. 11 Spot Bitcoin ETFs Here are the 11 SEC-approved Spot Bitcoin ETFs as of January 31, 2024: Spot Bitcoin ETF Expense Ratio Fee Waiver ARK 21Shares Bitcoin ETF (ARKB) 0.21% 0% fee for six months (or until $1 billion in assets) Bitwise Bitcoin ETF (BITB) 0.20% 0% fee for six months (or until $1 billion in assets) Fidelity Wise Origin Bitcoin Trust (FBTC) 0.25% Fees waived until July 31, 2024 Franklin Bitcoin ETF (EZBC) 0.19% 0% fee until August 2, 2024 (or until $10 billion in assets) Grayscale Bitcoin Trust (GBTC) 1.50% No fee waiver Hashdex Bitcoin ETF (DEFI)* 0.90% No fee waiver Invesco Galaxy Bitcoin ETF (BTCO) 0.25% 0% fee for six months (or until $5 billion in assets) iShares Bitcoin Trust (IBIT) 0.25% 0.12% fee for 12 months (or until $5 billion in assets) Valkyrie Bitcoin Fund (BRRR) 0.25% 0% fee for three months VanEck Bitcoin Trust (HODL) 0.25% No fee waiver See More * The Hashdex Bitcoin Futures ETF (DEFI) will convert to a spot bitcoin ETF at a later date. Now That They’re Here, What’s the Future of Spot Bitcoin ETFs? For years, the SEC had rejected all applications for a spot bitcoin ETF, with over 20 thumbs down between 2018 and 2023. The SEC’s approval of 11 spot bitcoin ETFs on January 10 marks a shift in how regulators treat cryptocurrencies. A flurry of new applications has been sent to the SEC for approval, suggesting even more spot bitcoin ETFs may be coming. It’s important to note that just because spot bitcoin ETFs have been approved, that does not mean the SEC is certain to approve additional crypto ETFs. Gary Gensler, chairman of the SEC, said in the SEC’s announcement of the approval of spot bitcoin ETFs, “Importantly, today’s Commission action is cabined to ETPs holding one non-security commodity, bitcoin. It should in no way signal the Commission’s willingness to approve listing standards for crypto asset securities.” Will Spot Bitcoin ETFs Affect the Price of Bitcoin? In the short term, more investors will find it easier to invest in bitcoin through these spot ETFs. This could mean more demand for bitcoin, as funds purchase from crypto exchanges to meet the demand of the spot ETFs. Bitcoin’s price was already rising in the weeks leading up to the spot bitcoin ETF announcement—and a “sell the news” moment happened in the wake of the approval. Many bitcoin holders became sellers, with the price of bitcoin dropping over 10% in just a few weeks. Over the long term, however, demand could increase for Bitcoin, as retirement plans, 401(k) plans and financial advisors start offering spot bitcoin ETFs as a way to diversify portfolios into “alternative assets.” “I personally believe that it will positively impact Bitcoin’s price because of increased adoption, easier access to ‘normies’ and increased liquidity in the marketplace,” says Marko Zlatic, founder of Whiteboard Finance. “Since the Bitcoin protocol dictates a finite supply of 21 million bitcoin ever, this should drive prices up over time, as long as there is adequate demand.” Risks of Investing in Spot Bitcoin ETFs Investors should understand the risk of investing in a spot bitcoin ETF before allocating any funds toward one. “Investors should approach cautiously and look at previous price movements of bitcoin to make sure they can stomach the volatility before they dive in,” says Christopher Johns, founder and wealth advisor at Spark Wealth Advisors, LLC. Gold had a similar trajectory when spot gold ETFs were introduced. The assets under management, or AUM, of spot gold ETFs quickly rose to about $1 billion. Since then, total holdings have grown to over $50 billion. This—along with other macroeconomic factors—has helped push the price of gold up to new highs. Spot Bitcoin ETFs: Pros And Cons Pros Bitcoin legitimacy. With the approval of spot bitcoin ETFs, the original cryptocurrency is now seen as a more legitimate asset class. Investors from all walks of life can gain exposure to bitcoin in almost any type of investment account they own, including individual retirement accounts, or IRAs, and 401(k)s. More liquidity. With ETFs buying and selling large blocks of bitcoin based on demand, this could increase liquidity and help stabilize prices over the long term. Increase prices. While a spot bitcoin ETF does not directly affect the price of bitcoin, the increased demand and purchasing of bitcoin by these ETFs could boost the price over time. Lower trading fees. With more adoption and ease of access through a spot ETF, investors may be able to access bitcoin with lower trading fees than some crypto exchanges. Cons More regulation. Spot bitcoin ETFs are highly-regulated securities that are now tied to the price of bitcoin. Any regulatory actions against bitcoin could affect the price of spot bitcoin ETFs—and bitcoin itself—as well. Investors don’t take custody of bitcoin. While investing in a spot bitcoin ETF gives you exposure to the price of bitcoin, you can’t take custody of the asset itself. “[You’re] trusting a third party custodian to ‘HODL’ your bitcoin. Not your keys, not your bitcoin,” Zlatic says. Annual fees. While trading spot bitcoin ETFs might cost less in the short term, the annual expense ratios may make it more expensive to own versus purchasing and storing bitcoin yourself. Volatility. While spot bitcoin ETFs will help increase bitcoin adoption, it is still a volatile asset that wildly fluctuates in price, which can hurt investors who aren’t prepared for the risk involved in owning bitcoin. Alternatives to Spot Bitcoin ETFs While investing in a spot bitcoin ETF can give you direct exposure to the price of bitcoin, it’s not the only way to invest in bitcoin. Here are a few alternatives to consider: Purchase bitcoin directly. If you want to own the actual asset yourself, you can purchase bitcoin from an online exchange. This gives you the ability to own bitcoin—or at least a portion of bitcoin—and take it into custody. There is a higher barrier to entry to owning bitcoin, as you’ll need to create a crypto exchange account, open a digital wallet and perhaps even transfer your bitcoin keys to a hardware wallet for safekeeping. Bitcoin futures ETF. Bitcoin futures ETFs have been around for a while, although they operate a bit differently than a spot ETF. These ETFs do not hold any bitcoin and only hold futures contracts based on the future price of bitcoin. This makes them potentially even more volatile than bitcoin itself. Bitcoin mining stocks. Bitcoin mining is a real business in which companies own and operate large data centers used for mining bitcoin. Some of these companies are publicly traded, allowing you to invest in the operation of mining bitcoin and the profit mining companies make in the process.
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{Instruction} ========== Only use the information in the context document. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context". ---------------- {Passage} ========== **Spot Bitcoin ETFs: What Are They, And How Do They Work?** Bitcoin has been one of the best-performing assets over the last decade, rising from a relatively obscure peer-to-peer payment network to a global phenomenon. As the original cryptocurrency, bitcoin has spurred an entirely new asset class that now has over $1 trillion in market capitalization. With the approval of 11 spot bitcoin ETFs in January 2024, traditional investors have an even easier way to invest in bitcoin. What Is a Spot Bitcoin ETF? On January 10, 2024, the SEC approved 11 new spot bitcoin ETFs. ETFs, or exchange-traded funds, are a type of security that tracks the underlying performance of a collection of assets or commodities. A spot bitcoin ETF is an exchange-traded fund that tracks the spot, or current price of bitcoin. By holding an equivalent amount of bitcoin to back every share of the ETF that is sold, the fund is actually backed by bitcoin itself. Considering the hoops you have to jump through to own bitcoin—exchange accounts, digital wallets, private keys, network transfers, etc.—a spot bitcoin ETF is one of the easiest ways to add bitcoin exposure to your portfolio. Spot ETFs, such as the new spot bitcoin ETFs, allow for shares of the fund to be created or redeemed based on market demand. In this way, a spot bitcoin ETF allows investors to gain exposure to the current price of bitcoin without having to hold the asset itself. This is in contrast to bitcoin futures ETFs, which were approved for trading by the U.S. Securities and Exchange Commission in October 2021 and can only trade bitcoin futures. Futures are complex derivatives instruments that track potential future prices of the underlying asset. How Do Spot Bitcoin ETFs Work? Spot bitcoin ETFs purchase a select amount of bitcoins that are held in a secure digital wallet by a custodian. These custodians offer bitcoin storage in a secure vault. Most of these vaults are—as crypto insiders call—air gapped in “cold storage,” which means the bitcoins’ keys are stored offline and cannot be accessed through the internet. The ETFs then issue shares that represent the bitcoins held by the fund. These shares are priced to reflect the current spot price of bitcoin and can be traded on traditional stock exchanges. Spot bitcoin ETFs make it easier for retail investors and traders to buy and sell an asset tied to the current value of bitcoin without needing to hold bitcoin itself. They also allow investors seeking exposure to bitcoin in retirement accounts to have a much simpler option than opening a self-directed IRA that could hold bitcoin directly. How Does a Spot ETF Maintain Its Price? The price of a spot ETF can depart from the actual value of the underlying asset. To bring the fund back in line with the asset’s actual value, authorized participants, otherwise known as APs, are allowed to create or redeem large blocks of shares. APs are typically large financial institutions that profit from the arbitrage opportunity presented when an ETF’s price is higher or lower than the underlying asset’s value. 11 Spot Bitcoin ETFs Here are the 11 SEC-approved Spot Bitcoin ETFs as of January 31, 2024: Spot Bitcoin ETF Expense Ratio Fee Waiver ARK 21Shares Bitcoin ETF (ARKB) 0.21% 0% fee for six months (or until $1 billion in assets) Bitwise Bitcoin ETF (BITB) 0.20% 0% fee for six months (or until $1 billion in assets) Fidelity Wise Origin Bitcoin Trust (FBTC) 0.25% Fees waived until July 31, 2024 Franklin Bitcoin ETF (EZBC) 0.19% 0% fee until August 2, 2024 (or until $10 billion in assets) Grayscale Bitcoin Trust (GBTC) 1.50% No fee waiver Hashdex Bitcoin ETF (DEFI)* 0.90% No fee waiver Invesco Galaxy Bitcoin ETF (BTCO) 0.25% 0% fee for six months (or until $5 billion in assets) iShares Bitcoin Trust (IBIT) 0.25% 0.12% fee for 12 months (or until $5 billion in assets) Valkyrie Bitcoin Fund (BRRR) 0.25% 0% fee for three months VanEck Bitcoin Trust (HODL) 0.25% No fee waiver See More * The Hashdex Bitcoin Futures ETF (DEFI) will convert to a spot bitcoin ETF at a later date. Now That They’re Here, What’s the Future of Spot Bitcoin ETFs? For years, the SEC had rejected all applications for a spot bitcoin ETF, with over 20 thumbs down between 2018 and 2023. The SEC’s approval of 11 spot bitcoin ETFs on January 10 marks a shift in how regulators treat cryptocurrencies. A flurry of new applications has been sent to the SEC for approval, suggesting even more spot bitcoin ETFs may be coming. It’s important to note that just because spot bitcoin ETFs have been approved, that does not mean the SEC is certain to approve additional crypto ETFs. Gary Gensler, chairman of the SEC, said in the SEC’s announcement of the approval of spot bitcoin ETFs, “Importantly, today’s Commission action is cabined to ETPs holding one non-security commodity, bitcoin. It should in no way signal the Commission’s willingness to approve listing standards for crypto asset securities.” Will Spot Bitcoin ETFs Affect the Price of Bitcoin? In the short term, more investors will find it easier to invest in bitcoin through these spot ETFs. This could mean more demand for bitcoin, as funds purchase from crypto exchanges to meet the demand of the spot ETFs. Bitcoin’s price was already rising in the weeks leading up to the spot bitcoin ETF announcement—and a “sell the news” moment happened in the wake of the approval. Many bitcoin holders became sellers, with the price of bitcoin dropping over 10% in just a few weeks. Over the long term, however, demand could increase for Bitcoin, as retirement plans, 401(k) plans and financial advisors start offering spot bitcoin ETFs as a way to diversify portfolios into “alternative assets.” “I personally believe that it will positively impact Bitcoin’s price because of increased adoption, easier access to ‘normies’ and increased liquidity in the marketplace,” says Marko Zlatic, founder of Whiteboard Finance. “Since the Bitcoin protocol dictates a finite supply of 21 million bitcoin ever, this should drive prices up over time, as long as there is adequate demand.” Risks of Investing in Spot Bitcoin ETFs Investors should understand the risk of investing in a spot bitcoin ETF before allocating any funds toward one. “Investors should approach cautiously and look at previous price movements of bitcoin to make sure they can stomach the volatility before they dive in,” says Christopher Johns, founder and wealth advisor at Spark Wealth Advisors, LLC. Gold had a similar trajectory when spot gold ETFs were introduced. The assets under management, or AUM, of spot gold ETFs quickly rose to about $1 billion. Since then, total holdings have grown to over $50 billion. This—along with other macroeconomic factors—has helped push the price of gold up to new highs. Spot Bitcoin ETFs: Pros And Cons Pros Bitcoin legitimacy. With the approval of spot bitcoin ETFs, the original cryptocurrency is now seen as a more legitimate asset class. Investors from all walks of life can gain exposure to bitcoin in almost any type of investment account they own, including individual retirement accounts, or IRAs, and 401(k)s. More liquidity. With ETFs buying and selling large blocks of bitcoin based on demand, this could increase liquidity and help stabilize prices over the long term. Increase prices. While a spot bitcoin ETF does not directly affect the price of bitcoin, the increased demand and purchasing of bitcoin by these ETFs could boost the price over time. Lower trading fees. With more adoption and ease of access through a spot ETF, investors may be able to access bitcoin with lower trading fees than some crypto exchanges. Cons More regulation. Spot bitcoin ETFs are highly-regulated securities that are now tied to the price of bitcoin. Any regulatory actions against bitcoin could affect the price of spot bitcoin ETFs—and bitcoin itself—as well. Investors don’t take custody of bitcoin. While investing in a spot bitcoin ETF gives you exposure to the price of bitcoin, you can’t take custody of the asset itself. “[You’re] trusting a third party custodian to ‘HODL’ your bitcoin. Not your keys, not your bitcoin,” Zlatic says. Annual fees. While trading spot bitcoin ETFs might cost less in the short term, the annual expense ratios may make it more expensive to own versus purchasing and storing bitcoin yourself. Volatility. While spot bitcoin ETFs will help increase bitcoin adoption, it is still a volatile asset that wildly fluctuates in price, which can hurt investors who aren’t prepared for the risk involved in owning bitcoin. Alternatives to Spot Bitcoin ETFs While investing in a spot bitcoin ETF can give you direct exposure to the price of bitcoin, it’s not the only way to invest in bitcoin. Here are a few alternatives to consider: Purchase bitcoin directly. If you want to own the actual asset yourself, you can purchase bitcoin from an online exchange. This gives you the ability to own bitcoin—or at least a portion of bitcoin—and take it into custody. There is a higher barrier to entry to owning bitcoin, as you’ll need to create a crypto exchange account, open a digital wallet and perhaps even transfer your bitcoin keys to a hardware wallet for safekeeping. Bitcoin futures ETF. Bitcoin futures ETFs have been around for a while, although they operate a bit differently than a spot ETF. These ETFs do not hold any bitcoin and only hold futures contracts based on the future price of bitcoin. This makes them potentially even more volatile than bitcoin itself. Bitcoin mining stocks. Bitcoin mining is a real business in which companies own and operate large data centers used for mining bitcoin. Some of these companies are publicly traded, allowing you to invest in the operation of mining bitcoin and the profit mining companies make in the process. ---------------- {Question} ========== According to the context document only, how can APs profit from a Bitcoin ETF?
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Only use the information in the context document. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context".
EVIDENCE:
**Spot Bitcoin ETFs: What Are They, And How Do They Work?** Bitcoin has been one of the best-performing assets over the last decade, rising from a relatively obscure peer-to-peer payment network to a global phenomenon. As the original cryptocurrency, bitcoin has spurred an entirely new asset class that now has over $1 trillion in market capitalization. With the approval of 11 spot bitcoin ETFs in January 2024, traditional investors have an even easier way to invest in bitcoin. What Is a Spot Bitcoin ETF? On January 10, 2024, the SEC approved 11 new spot bitcoin ETFs. ETFs, or exchange-traded funds, are a type of security that tracks the underlying performance of a collection of assets or commodities. A spot bitcoin ETF is an exchange-traded fund that tracks the spot, or current price of bitcoin. By holding an equivalent amount of bitcoin to back every share of the ETF that is sold, the fund is actually backed by bitcoin itself. Considering the hoops you have to jump through to own bitcoin—exchange accounts, digital wallets, private keys, network transfers, etc.—a spot bitcoin ETF is one of the easiest ways to add bitcoin exposure to your portfolio. Spot ETFs, such as the new spot bitcoin ETFs, allow for shares of the fund to be created or redeemed based on market demand. In this way, a spot bitcoin ETF allows investors to gain exposure to the current price of bitcoin without having to hold the asset itself. This is in contrast to bitcoin futures ETFs, which were approved for trading by the U.S. Securities and Exchange Commission in October 2021 and can only trade bitcoin futures. Futures are complex derivatives instruments that track potential future prices of the underlying asset. How Do Spot Bitcoin ETFs Work? Spot bitcoin ETFs purchase a select amount of bitcoins that are held in a secure digital wallet by a custodian. These custodians offer bitcoin storage in a secure vault. Most of these vaults are—as crypto insiders call—air gapped in “cold storage,” which means the bitcoins’ keys are stored offline and cannot be accessed through the internet. The ETFs then issue shares that represent the bitcoins held by the fund. These shares are priced to reflect the current spot price of bitcoin and can be traded on traditional stock exchanges. Spot bitcoin ETFs make it easier for retail investors and traders to buy and sell an asset tied to the current value of bitcoin without needing to hold bitcoin itself. They also allow investors seeking exposure to bitcoin in retirement accounts to have a much simpler option than opening a self-directed IRA that could hold bitcoin directly. How Does a Spot ETF Maintain Its Price? The price of a spot ETF can depart from the actual value of the underlying asset. To bring the fund back in line with the asset’s actual value, authorized participants, otherwise known as APs, are allowed to create or redeem large blocks of shares. APs are typically large financial institutions that profit from the arbitrage opportunity presented when an ETF’s price is higher or lower than the underlying asset’s value. 11 Spot Bitcoin ETFs Here are the 11 SEC-approved Spot Bitcoin ETFs as of January 31, 2024: Spot Bitcoin ETF Expense Ratio Fee Waiver ARK 21Shares Bitcoin ETF (ARKB) 0.21% 0% fee for six months (or until $1 billion in assets) Bitwise Bitcoin ETF (BITB) 0.20% 0% fee for six months (or until $1 billion in assets) Fidelity Wise Origin Bitcoin Trust (FBTC) 0.25% Fees waived until July 31, 2024 Franklin Bitcoin ETF (EZBC) 0.19% 0% fee until August 2, 2024 (or until $10 billion in assets) Grayscale Bitcoin Trust (GBTC) 1.50% No fee waiver Hashdex Bitcoin ETF (DEFI)* 0.90% No fee waiver Invesco Galaxy Bitcoin ETF (BTCO) 0.25% 0% fee for six months (or until $5 billion in assets) iShares Bitcoin Trust (IBIT) 0.25% 0.12% fee for 12 months (or until $5 billion in assets) Valkyrie Bitcoin Fund (BRRR) 0.25% 0% fee for three months VanEck Bitcoin Trust (HODL) 0.25% No fee waiver See More * The Hashdex Bitcoin Futures ETF (DEFI) will convert to a spot bitcoin ETF at a later date. Now That They’re Here, What’s the Future of Spot Bitcoin ETFs? For years, the SEC had rejected all applications for a spot bitcoin ETF, with over 20 thumbs down between 2018 and 2023. The SEC’s approval of 11 spot bitcoin ETFs on January 10 marks a shift in how regulators treat cryptocurrencies. A flurry of new applications has been sent to the SEC for approval, suggesting even more spot bitcoin ETFs may be coming. It’s important to note that just because spot bitcoin ETFs have been approved, that does not mean the SEC is certain to approve additional crypto ETFs. Gary Gensler, chairman of the SEC, said in the SEC’s announcement of the approval of spot bitcoin ETFs, “Importantly, today’s Commission action is cabined to ETPs holding one non-security commodity, bitcoin. It should in no way signal the Commission’s willingness to approve listing standards for crypto asset securities.” Will Spot Bitcoin ETFs Affect the Price of Bitcoin? In the short term, more investors will find it easier to invest in bitcoin through these spot ETFs. This could mean more demand for bitcoin, as funds purchase from crypto exchanges to meet the demand of the spot ETFs. Bitcoin’s price was already rising in the weeks leading up to the spot bitcoin ETF announcement—and a “sell the news” moment happened in the wake of the approval. Many bitcoin holders became sellers, with the price of bitcoin dropping over 10% in just a few weeks. Over the long term, however, demand could increase for Bitcoin, as retirement plans, 401(k) plans and financial advisors start offering spot bitcoin ETFs as a way to diversify portfolios into “alternative assets.” “I personally believe that it will positively impact Bitcoin’s price because of increased adoption, easier access to ‘normies’ and increased liquidity in the marketplace,” says Marko Zlatic, founder of Whiteboard Finance. “Since the Bitcoin protocol dictates a finite supply of 21 million bitcoin ever, this should drive prices up over time, as long as there is adequate demand.” Risks of Investing in Spot Bitcoin ETFs Investors should understand the risk of investing in a spot bitcoin ETF before allocating any funds toward one. “Investors should approach cautiously and look at previous price movements of bitcoin to make sure they can stomach the volatility before they dive in,” says Christopher Johns, founder and wealth advisor at Spark Wealth Advisors, LLC. Gold had a similar trajectory when spot gold ETFs were introduced. The assets under management, or AUM, of spot gold ETFs quickly rose to about $1 billion. Since then, total holdings have grown to over $50 billion. This—along with other macroeconomic factors—has helped push the price of gold up to new highs. Spot Bitcoin ETFs: Pros And Cons Pros Bitcoin legitimacy. With the approval of spot bitcoin ETFs, the original cryptocurrency is now seen as a more legitimate asset class. Investors from all walks of life can gain exposure to bitcoin in almost any type of investment account they own, including individual retirement accounts, or IRAs, and 401(k)s. More liquidity. With ETFs buying and selling large blocks of bitcoin based on demand, this could increase liquidity and help stabilize prices over the long term. Increase prices. While a spot bitcoin ETF does not directly affect the price of bitcoin, the increased demand and purchasing of bitcoin by these ETFs could boost the price over time. Lower trading fees. With more adoption and ease of access through a spot ETF, investors may be able to access bitcoin with lower trading fees than some crypto exchanges. Cons More regulation. Spot bitcoin ETFs are highly-regulated securities that are now tied to the price of bitcoin. Any regulatory actions against bitcoin could affect the price of spot bitcoin ETFs—and bitcoin itself—as well. Investors don’t take custody of bitcoin. While investing in a spot bitcoin ETF gives you exposure to the price of bitcoin, you can’t take custody of the asset itself. “[You’re] trusting a third party custodian to ‘HODL’ your bitcoin. Not your keys, not your bitcoin,” Zlatic says. Annual fees. While trading spot bitcoin ETFs might cost less in the short term, the annual expense ratios may make it more expensive to own versus purchasing and storing bitcoin yourself. Volatility. While spot bitcoin ETFs will help increase bitcoin adoption, it is still a volatile asset that wildly fluctuates in price, which can hurt investors who aren’t prepared for the risk involved in owning bitcoin. Alternatives to Spot Bitcoin ETFs While investing in a spot bitcoin ETF can give you direct exposure to the price of bitcoin, it’s not the only way to invest in bitcoin. Here are a few alternatives to consider: Purchase bitcoin directly. If you want to own the actual asset yourself, you can purchase bitcoin from an online exchange. This gives you the ability to own bitcoin—or at least a portion of bitcoin—and take it into custody. There is a higher barrier to entry to owning bitcoin, as you’ll need to create a crypto exchange account, open a digital wallet and perhaps even transfer your bitcoin keys to a hardware wallet for safekeeping. Bitcoin futures ETF. Bitcoin futures ETFs have been around for a while, although they operate a bit differently than a spot ETF. These ETFs do not hold any bitcoin and only hold futures contracts based on the future price of bitcoin. This makes them potentially even more volatile than bitcoin itself. Bitcoin mining stocks. Bitcoin mining is a real business in which companies own and operate large data centers used for mining bitcoin. Some of these companies are publicly traded, allowing you to invest in the operation of mining bitcoin and the profit mining companies make in the process.
USER:
According to the context document only, how can APs profit from a Bitcoin ETF?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 29 | 14 | 1,635 | null | 429 |
You are given a reference document. You must only use information found in the reference document to answer the question asked.
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How did Goldman Sachs recover from losses caused by the mortgage crisis referenced in this email conversation?
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From: Sent: To: Cc: Subject: Cohn, Gary (EO 85830) Sunday, November 18, 2007 6:04 PM Blankfein, Uoyd (EO 85830); van Praag, Lucas (EO PBC09) Winkelried, Jon (EO 85830); Viniar, David; Rogee, John F.W. (EO 85830); Horwitz, Russell (EO 85830) Re: NYT We were just smaller in the toxic products ----- Original Message From: Blank fein, Lloyd To: van Praag, Lucas Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Sent: Sun Nov 18 17:59:01 2007 Subject: RE: NYT Of course we didn't dodge the mortgage mess. We lost money, then made more than we lost because of shorts. Also, it's not over, so who knows how it will turn out Ultimately. -----Original Message----From: van Praag, Lucas Sent: Sunday, November 18, 2007 5:47 PM To: Blankfein, Lloyd Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Subject: NYT Jenny Anderson and Landon Thomas' story about how we dodged the mortgage mess is scheduled to run tomorrow. At this stage, 95% certain to be on the front page. I don't expect it to be materially different to the WSJ story on the same subject that ran last week - although it will have more color and annecdotes. Have given John and Russell a detailed briefing and Russell will update you on the plane, but here are a few points: 1 I have Agreed to brief Jenny thoroughly on it tomorrow and expect the news to run either Tues or Wed. I think it would be good if you had a 5 min phone call with her on the subject and I'll liaise with Russell on timing. We will issue the press release to coincide with publication of her article and will actively work with other media, esp in the UK, to make sure the message is spread and picked up effectively. 2. Tomorrow's story will, of course, have 'balance' (ie stuff we don't like). In this instance, we have spent much time discussing conflicts, and I think we've made some progress as she aknowledges that most of her sources on the subject are financial sponsors which fact, unless edited out, is included and gives context. 3, The article references the extraordinary influence Goldman Sachs has - the most topical being John Thain, but Rubin, Hank, Duncan et al are all in the mix too. She hasn't gone as far as suggesting that there is a credible conspiracy theory (unlike her former colleague at the NY Post). She does, however, make the point that it feels like GS is running everything. 5. We spent a lot of time on culture as a differentiator - she was receptive. 4. She has used several remarks you made at the ML conference on the record - which is If anything changes, I ' l l let you know. I L ---,:;;;eeee-;,;;,;.-_ .. From: Sent: To: Subject: Swenson, Michael Thursday. October 11, 2007 7:06 PM Mullen, Donald RE: Early post on P and L _ = Redacled by the Pennanent Yes we are well positioned -----Original Message----e From: Mullen, Donald Sent: Thursday, October 11, 2001 6:21 To: Swenson, Michael Subject: Re: Early post on P and L Sounds like we will make some serious money ----- Original Message From: Swenson, Michael To: Mullen, Donald Sent: Thu Oct 11 16:24:00 2001 SUbject: RE: Early post on e and L The . . . . . . CDO has a bunch of second lien positions 1n it that have been written down, The collateral balance has fallen below the liabilities triggering an "implied write-down event" which is a credit event in our CDS document. Unlike RMBS structures, COOs do not have a bond write-down feature. On another note, today's RMBS downgrades by Moody's should cause many COOs to fail their triggers. That will result in coupons being shut off on the bonds and hence our CDS protection premie paid out will go to zero. -----Original Message----erom: Mullen, Donald Sent: Thursday, October 11, 2001 5:49 To: Swenson, Michael Subject: Re: Early post on e and L Nice day How did the trigger not work ----- original Message ----From: Swenson, Michael To: Mullen, Donald; Montag, Tom Cc: Sparks, Daniel L; Brafman, Lester R Sent: Thu Oct 11 11:41:02 2001 Subject: Early post on e and L Moody's downgraded 32bb of of 2006 AA, A, BBB and BBB- bonds today. This will eventually filter into downgrades 1n COOs. ABX single-As sold off by a point after the news. ASS Desk P and L will be up between 30 and 35mm today, 12mm of the p and 1 is from our first credit event in COOs where the implied trigger failed on a e deal e 06-1) • Goldman, Sachs & Co, ***** From: Sent: To: Ce, Salem, Deeb Thursday, May 17, 20078:06 AM Swenson, Michael Chin, Edwin Subject, bad news .. , FW, lBMl06A wipes out the m6s and makes a wipeout on the m5 imminent. ,. costs us about 2,5mm 3,5 m6 12.5 m5 marked at $10 marked at $20 good news, , , we own 10mm protection on the m6 marked at $50 "., we make $5mm From: ....t ce, To: Subject: Thlxsday, May 17, 2007 8:00 AM salem, Deeb; Olin, Edwin Poue, Darlush; BrOsterman, Jonathan LBMlO6A -.,- 06:0717May2007 LONG BEACH MORTGAGE LOAN TRUST 2006-A FILES (8-K) Disclosing Other Events May 17 (EDGAR Online)· Item 8.01 Other Events Long Beach Mortgage securities Corp announces that the May 2007 distribution report fOf LBMLT 2OQ6.A will reflect that 616 second-lien mortgage loans with an aggregate urpaid principal balance of $ 49,340.870.90 will be dlarged off on May 25.2007. The total amOllnt to be charged off, $52,797,628.59, includes certain unreimbursed advances of principal and interest made by the servicer, Washington Mutual Bank. Information regarding the characteristics of the loans in LBMLT 2006·A is available from the trustee at its website httos:/Itss.db.oom/invr and at http://wmsubprime.lewtan.CQm. The table below sets forth the numbet' and aggregate unpaid principal balance of the charged otf mortgage loans by distribution date (the month following the due dale of the last monthly payment that should have been received with respect to the klans). The chargeoff assessment date tor the pool was May 1, 2007. Distritution Date November 2006 December 2006 January 2007 February 2007 7,163 March 2007 April 2007 May 2007 Number of Loans in 7,767 7,624 7,468 7,305 6,997 TBO" Pool Aggregate Unpaid $465,292,702.94 S475,682,053.93 S465,992,547.68 S455,518,577.5O $444,362,214.18 $434,469,820.04 charged off for reasons other than 180 days delinquency. Due to the numbef of affected mortgage loans fO( the May 2007 distribution date, there may be a larger than usual reconciliation activity on the remittance report for the June 2007 distribution date to reflect items that have not been closed out as of the scheduled reporting date to the trustee for the May 2007 distribution date. Please Contact: Doug Potolsky at (212) 702- 6961 if you have any questions about this filing. From: Sent: To: Subject: Viniar, David Wednesday, July 25,20079:18 PM Cohn, Gary (EO 85630) RE: Private & Confidential: FICC Financial Package 07125/07 Confidential Sensitivity: Tells you what might be happening to people who don't have the big short. -----Original Message----From: Cohn, Gary (EO 85B30) Sent: Wednesday, July 25, 2007 8:55 PM To: Viniar, David; Blankfein, Lloyd (EO 85B30); Winkelried, Jon (EO 65B30) SUbject: Fw: Private & Confidential: FICC Financial Package 07/25/07 Sensitivity: Confidential Look at the Mortgage numbers up 373 in the index book and wrote down 230 in etO-COO and. 92 in resids Original Message ----From: Tricarico, Geoffrey P. To: ficc-package Sent: Wed Jul 25 19:33:10 2007 Subject: Private & Confidential: FICC Financial Package 07/25/07 REVENUES (Including Estimate) EST $ 126.5
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You are given a reference document. You must only use information found in the reference document to answer the question asked. How did Goldman Sachs recover from losses caused by the mortgage crisis referenced in this email conversation? From: Sent: To: Cc: Subject: Cohn, Gary (EO 85830) Sunday, November 18, 2007 6:04 PM Blankfein, Uoyd (EO 85830); van Praag, Lucas (EO PBC09) Winkelried, Jon (EO 85830); Viniar, David; Rogee, John F.W. (EO 85830); Horwitz, Russell (EO 85830) Re: NYT We were just smaller in the toxic products ----- Original Message From: Blank fein, Lloyd To: van Praag, Lucas Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Sent: Sun Nov 18 17:59:01 2007 Subject: RE: NYT Of course we didn't dodge the mortgage mess. We lost money, then made more than we lost because of shorts. Also, it's not over, so who knows how it will turn out Ultimately. -----Original Message----From: van Praag, Lucas Sent: Sunday, November 18, 2007 5:47 PM To: Blankfein, Lloyd Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Subject: NYT Jenny Anderson and Landon Thomas' story about how we dodged the mortgage mess is scheduled to run tomorrow. At this stage, 95% certain to be on the front page. I don't expect it to be materially different to the WSJ story on the same subject that ran last week - although it will have more color and annecdotes. Have given John and Russell a detailed briefing and Russell will update you on the plane, but here are a few points: 1 I have Agreed to brief Jenny thoroughly on it tomorrow and expect the news to run either Tues or Wed. I think it would be good if you had a 5 min phone call with her on the subject and I'll liaise with Russell on timing. We will issue the press release to coincide with publication of her article and will actively work with other media, esp in the UK, to make sure the message is spread and picked up effectively. 2. Tomorrow's story will, of course, have 'balance' (ie stuff we don't like). In this instance, we have spent much time discussing conflicts, and I think we've made some progress as she aknowledges that most of her sources on the subject are financial sponsors which fact, unless edited out, is included and gives context. 3, The article references the extraordinary influence Goldman Sachs has - the most topical being John Thain, but Rubin, Hank, Duncan et al are all in the mix too. She hasn't gone as far as suggesting that there is a credible conspiracy theory (unlike her former colleague at the NY Post). She does, however, make the point that it feels like GS is running everything. 5. We spent a lot of time on culture as a differentiator - she was receptive. 4. She has used several remarks you made at the ML conference on the record - which is If anything changes, I ' l l let you know. I L ---,:;;;eeee-;,;;,;.-_ .. From: Sent: To: Subject: Swenson, Michael Thursday. October 11, 2007 7:06 PM Mullen, Donald RE: Early post on P and L _ = Redacled by the Pennanent Yes we are well positioned -----Original Message----e From: Mullen, Donald Sent: Thursday, October 11, 2001 6:21 To: Swenson, Michael Subject: Re: Early post on P and L Sounds like we will make some serious money ----- Original Message From: Swenson, Michael To: Mullen, Donald Sent: Thu Oct 11 16:24:00 2001 SUbject: RE: Early post on e and L The . . . . . . CDO has a bunch of second lien positions 1n it that have been written down, The collateral balance has fallen below the liabilities triggering an "implied write-down event" which is a credit event in our CDS document. Unlike RMBS structures, COOs do not have a bond write-down feature. On another note, today's RMBS downgrades by Moody's should cause many COOs to fail their triggers. That will result in coupons being shut off on the bonds and hence our CDS protection premie paid out will go to zero. -----Original Message----erom: Mullen, Donald Sent: Thursday, October 11, 2001 5:49 To: Swenson, Michael Subject: Re: Early post on e and L Nice day How did the trigger not work ----- original Message ----From: Swenson, Michael To: Mullen, Donald; Montag, Tom Cc: Sparks, Daniel L; Brafman, Lester R Sent: Thu Oct 11 11:41:02 2001 Subject: Early post on e and L Moody's downgraded 32bb of of 2006 AA, A, BBB and BBB- bonds today. This will eventually filter into downgrades 1n COOs. ABX single-As sold off by a point after the news. ASS Desk P and L will be up between 30 and 35mm today, 12mm of the p and 1 is from our first credit event in COOs where the implied trigger failed on a e deal e 06-1) • Goldman, Sachs & Co, ***** From: Sent: To: Ce, Salem, Deeb Thursday, May 17, 20078:06 AM Swenson, Michael Chin, Edwin Subject, bad news .. , FW, lBMl06A wipes out the m6s and makes a wipeout on the m5 imminent. ,. costs us about 2,5mm 3,5 m6 12.5 m5 marked at $10 marked at $20 good news, , , we own 10mm protection on the m6 marked at $50 "., we make $5mm From: ....t ce, To: Subject: Thlxsday, May 17, 2007 8:00 AM salem, Deeb; Olin, Edwin Poue, Darlush; BrOsterman, Jonathan LBMlO6A -.,- 06:0717May2007 LONG BEACH MORTGAGE LOAN TRUST 2006-A FILES (8-K) Disclosing Other Events May 17 (EDGAR Online)· Item 8.01 Other Events Long Beach Mortgage securities Corp announces that the May 2007 distribution report fOf LBMLT 2OQ6.A will reflect that 616 second-lien mortgage loans with an aggregate urpaid principal balance of $ 49,340.870.90 will be dlarged off on May 25.2007. The total amOllnt to be charged off, $52,797,628.59, includes certain unreimbursed advances of principal and interest made by the servicer, Washington Mutual Bank. Information regarding the characteristics of the loans in LBMLT 2006·A is available from the trustee at its website httos:/Itss.db.oom/invr and at http://wmsubprime.lewtan.CQm. The table below sets forth the numbet' and aggregate unpaid principal balance of the charged otf mortgage loans by distribution date (the month following the due dale of the last monthly payment that should have been received with respect to the klans). The chargeoff assessment date tor the pool was May 1, 2007. Distritution Date November 2006 December 2006 January 2007 February 2007 7,163 March 2007 April 2007 May 2007 Number of Loans in 7,767 7,624 7,468 7,305 6,997 TBO" Pool Aggregate Unpaid $465,292,702.94 S475,682,053.93 S465,992,547.68 S455,518,577.5O $444,362,214.18 $434,469,820.04 charged off for reasons other than 180 days delinquency. Due to the numbef of affected mortgage loans fO( the May 2007 distribution date, there may be a larger than usual reconciliation activity on the remittance report for the June 2007 distribution date to reflect items that have not been closed out as of the scheduled reporting date to the trustee for the May 2007 distribution date. Please Contact: Doug Potolsky at (212) 702- 6961 if you have any questions about this filing. From: Sent: To: Subject: Viniar, David Wednesday, July 25,20079:18 PM Cohn, Gary (EO 85630) RE: Private & Confidential: FICC Financial Package 07125/07 Confidential Sensitivity: Tells you what might be happening to people who don't have the big short. -----Original Message----From: Cohn, Gary (EO 85B30) Sent: Wednesday, July 25, 2007 8:55 PM To: Viniar, David; Blankfein, Lloyd (EO 85B30); Winkelried, Jon (EO 65B30) SUbject: Fw: Private & Confidential: FICC Financial Package 07/25/07 Sensitivity: Confidential Look at the Mortgage numbers up 373 in the index book and wrote down 230 in etO-COO and. 92 in resids Original Message ----From: Tricarico, Geoffrey P. To: ficc-package Sent: Wed Jul 25 19:33:10 2007 Subject: Private & Confidential: FICC Financial Package 07/25/07 REVENUES (Including Estimate) EST $ 126.5
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You are given a reference document. You must only use information found in the reference document to answer the question asked.
EVIDENCE:
From: Sent: To: Cc: Subject: Cohn, Gary (EO 85830) Sunday, November 18, 2007 6:04 PM Blankfein, Uoyd (EO 85830); van Praag, Lucas (EO PBC09) Winkelried, Jon (EO 85830); Viniar, David; Rogee, John F.W. (EO 85830); Horwitz, Russell (EO 85830) Re: NYT We were just smaller in the toxic products ----- Original Message From: Blank fein, Lloyd To: van Praag, Lucas Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Sent: Sun Nov 18 17:59:01 2007 Subject: RE: NYT Of course we didn't dodge the mortgage mess. We lost money, then made more than we lost because of shorts. Also, it's not over, so who knows how it will turn out Ultimately. -----Original Message----From: van Praag, Lucas Sent: Sunday, November 18, 2007 5:47 PM To: Blankfein, Lloyd Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Subject: NYT Jenny Anderson and Landon Thomas' story about how we dodged the mortgage mess is scheduled to run tomorrow. At this stage, 95% certain to be on the front page. I don't expect it to be materially different to the WSJ story on the same subject that ran last week - although it will have more color and annecdotes. Have given John and Russell a detailed briefing and Russell will update you on the plane, but here are a few points: 1 I have Agreed to brief Jenny thoroughly on it tomorrow and expect the news to run either Tues or Wed. I think it would be good if you had a 5 min phone call with her on the subject and I'll liaise with Russell on timing. We will issue the press release to coincide with publication of her article and will actively work with other media, esp in the UK, to make sure the message is spread and picked up effectively. 2. Tomorrow's story will, of course, have 'balance' (ie stuff we don't like). In this instance, we have spent much time discussing conflicts, and I think we've made some progress as she aknowledges that most of her sources on the subject are financial sponsors which fact, unless edited out, is included and gives context. 3, The article references the extraordinary influence Goldman Sachs has - the most topical being John Thain, but Rubin, Hank, Duncan et al are all in the mix too. She hasn't gone as far as suggesting that there is a credible conspiracy theory (unlike her former colleague at the NY Post). She does, however, make the point that it feels like GS is running everything. 5. We spent a lot of time on culture as a differentiator - she was receptive. 4. She has used several remarks you made at the ML conference on the record - which is If anything changes, I ' l l let you know. I L ---,:;;;eeee-;,;;,;.-_ .. From: Sent: To: Subject: Swenson, Michael Thursday. October 11, 2007 7:06 PM Mullen, Donald RE: Early post on P and L _ = Redacled by the Pennanent Yes we are well positioned -----Original Message----e From: Mullen, Donald Sent: Thursday, October 11, 2001 6:21 To: Swenson, Michael Subject: Re: Early post on P and L Sounds like we will make some serious money ----- Original Message From: Swenson, Michael To: Mullen, Donald Sent: Thu Oct 11 16:24:00 2001 SUbject: RE: Early post on e and L The . . . . . . CDO has a bunch of second lien positions 1n it that have been written down, The collateral balance has fallen below the liabilities triggering an "implied write-down event" which is a credit event in our CDS document. Unlike RMBS structures, COOs do not have a bond write-down feature. On another note, today's RMBS downgrades by Moody's should cause many COOs to fail their triggers. That will result in coupons being shut off on the bonds and hence our CDS protection premie paid out will go to zero. -----Original Message----erom: Mullen, Donald Sent: Thursday, October 11, 2001 5:49 To: Swenson, Michael Subject: Re: Early post on e and L Nice day How did the trigger not work ----- original Message ----From: Swenson, Michael To: Mullen, Donald; Montag, Tom Cc: Sparks, Daniel L; Brafman, Lester R Sent: Thu Oct 11 11:41:02 2001 Subject: Early post on e and L Moody's downgraded 32bb of of 2006 AA, A, BBB and BBB- bonds today. This will eventually filter into downgrades 1n COOs. ABX single-As sold off by a point after the news. ASS Desk P and L will be up between 30 and 35mm today, 12mm of the p and 1 is from our first credit event in COOs where the implied trigger failed on a e deal e 06-1) • Goldman, Sachs & Co, ***** From: Sent: To: Ce, Salem, Deeb Thursday, May 17, 20078:06 AM Swenson, Michael Chin, Edwin Subject, bad news .. , FW, lBMl06A wipes out the m6s and makes a wipeout on the m5 imminent. ,. costs us about 2,5mm 3,5 m6 12.5 m5 marked at $10 marked at $20 good news, , , we own 10mm protection on the m6 marked at $50 "., we make $5mm From: ....t ce, To: Subject: Thlxsday, May 17, 2007 8:00 AM salem, Deeb; Olin, Edwin Poue, Darlush; BrOsterman, Jonathan LBMlO6A -.,- 06:0717May2007 LONG BEACH MORTGAGE LOAN TRUST 2006-A FILES (8-K) Disclosing Other Events May 17 (EDGAR Online)· Item 8.01 Other Events Long Beach Mortgage securities Corp announces that the May 2007 distribution report fOf LBMLT 2OQ6.A will reflect that 616 second-lien mortgage loans with an aggregate urpaid principal balance of $ 49,340.870.90 will be dlarged off on May 25.2007. The total amOllnt to be charged off, $52,797,628.59, includes certain unreimbursed advances of principal and interest made by the servicer, Washington Mutual Bank. Information regarding the characteristics of the loans in LBMLT 2006·A is available from the trustee at its website httos:/Itss.db.oom/invr and at http://wmsubprime.lewtan.CQm. The table below sets forth the numbet' and aggregate unpaid principal balance of the charged otf mortgage loans by distribution date (the month following the due dale of the last monthly payment that should have been received with respect to the klans). The chargeoff assessment date tor the pool was May 1, 2007. Distritution Date November 2006 December 2006 January 2007 February 2007 7,163 March 2007 April 2007 May 2007 Number of Loans in 7,767 7,624 7,468 7,305 6,997 TBO" Pool Aggregate Unpaid $465,292,702.94 S475,682,053.93 S465,992,547.68 S455,518,577.5O $444,362,214.18 $434,469,820.04 charged off for reasons other than 180 days delinquency. Due to the numbef of affected mortgage loans fO( the May 2007 distribution date, there may be a larger than usual reconciliation activity on the remittance report for the June 2007 distribution date to reflect items that have not been closed out as of the scheduled reporting date to the trustee for the May 2007 distribution date. Please Contact: Doug Potolsky at (212) 702- 6961 if you have any questions about this filing. From: Sent: To: Subject: Viniar, David Wednesday, July 25,20079:18 PM Cohn, Gary (EO 85630) RE: Private & Confidential: FICC Financial Package 07125/07 Confidential Sensitivity: Tells you what might be happening to people who don't have the big short. -----Original Message----From: Cohn, Gary (EO 85B30) Sent: Wednesday, July 25, 2007 8:55 PM To: Viniar, David; Blankfein, Lloyd (EO 85B30); Winkelried, Jon (EO 65B30) SUbject: Fw: Private & Confidential: FICC Financial Package 07/25/07 Sensitivity: Confidential Look at the Mortgage numbers up 373 in the index book and wrote down 230 in etO-COO and. 92 in resids Original Message ----From: Tricarico, Geoffrey P. To: ficc-package Sent: Wed Jul 25 19:33:10 2007 Subject: Private & Confidential: FICC Financial Package 07/25/07 REVENUES (Including Estimate) EST $ 126.5
USER:
How did Goldman Sachs recover from losses caused by the mortgage crisis referenced in this email conversation?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 21 | 17 | 1,270 | null | 125 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
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Tell me the advantages and disadvantages of smartphones in our lives with one or two sentences for each one. Also give me three examples for healthcare services of smartphones and one example of being dangerous for our lives.
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We are living in the era of gadgets and smartphones, and communication has never been so easy; with social media, we’re always connected to our friends and millions of other people, no matter where we are. All we need is a smartphone with an internet connection. Mobile phones have become part of our daily lives and besides communication, we have available a vast variety of apps that can make our daily life a lot easier. Though the cost of app development is rising, the number of apps in app stores is increasing. Some of these apps had been optimized for mobile apps stores so that we can find them easier. However, being in the business of making apps, we must question what’s the impact of mobile phones in our lives and society? In this article, we’ll look into what are the positive and negative effects of using mobile phones on a daily basis. Negative effects of mobile phones in our lives 1. Waste of time As much we love what nowadays smartphones can do for us, this technology also has a downside. A recent study from the digital analytic firm Flurry shows that we surprisingly spend on average almost 3-4 hours a day staring at our smart devices, totalizing nearly one day every week! One day, that’s right! 2. Addiction Phones addiction has a name: nomophobia, the fear of being out of cell phone contact. Therefore, not just spending too much time on our devices is a sign of addiction, but the fear of not having them on us as well. Like any other form of addiction, studies show that people that are addicted to their phones often show signs of depression, anxiety, and other forms of mental health problems. 3. Distraction Another study, this time from Florida State University, says that smartphones notifications can impair our concentration, even being short in duration they cause enough of a distraction to affect your ability to focus on a given task, decreasing your performance by prompting task-irrelevant thoughts and mind-wandering. This can be very dangerous in some specific situations, like driving, for instance, a simple notification can cause really serious accidents. 4. Affecting social skills Besides the problems mentioned above, it also has a huge impact on people’s social lives, people are getting more disconnected from the real world, they put their phones ahead of human interaction, it’s getting harder to see people talking to each other in public places, they’re always too busy with their mobile devices, checking notifications, sending messages or just sharing a new video. Our social skills seem to diminish constantly due to the overuse of smartphones and turning us into “smombie”. “Smartphone zombies” or “smombie” regularly cross our ways, perhaps you’re not familiar with the term but most likely you saw one today. They’re the people on public streets and places who walk slowly in peculiar ways with their eyes and fingers focused on your phone display. But it isn’t just road safety at stake here: think about how often they bump into things. The technology that drives mobile devices has improved a lot since they appeared, and especially in the last ten years. Mobile gadgets have gotten smaller, more powerful, and very useful. They are everywhere and play increasingly greater roles in the lives of most everyone. Positive effects of mobile phones in our life 1. Communication Besides the dark part of mobile technology, in the form of phones, tablets, and notebooks, is making our lives better than ever before. It does this in many ways, not the least of which is making communications routine. We can be in touch with those we need to reach, whether work-related or personal in nature. Mobile technology has changed the way we do business for the better. Never have we been able to share so much with friends and family as we can today, and that is in great part due to mobile technology. Without mobile devices and the technology behind them, participation in social networking would never have grown as much as it has. Sharing seemingly trivial information like where we are, what we are doing, and what that looks like significantly impacts our relationships with friends and loved ones. Mobile technology has given a voice to those otherwise cut off from the world during cataclysmic events. That voice can reach out for help when local tragedy strikes, and for the first time, these people are not alone. They can share their plight using mobile communication through text, voice, and, most importantly, images, and bring about real change. 2. Daily utilities Mobile phones have changed the way we live our lives. Now, not only can they help us stay connected with friends and family over social media or talk to someone on a video call without paying for data usage, but they also make everything from booking hotels and cabs to capturing memories easier than ever before thanks to their built-in cameras! We have more information in our hands than at any time in history. It has become second nature to quickly lookup helpful resources for whatever activity we need to do. Our gadgets can even anticipate what information we need and present it to us when it is most useful. 3. Healthcare services While mobile phones has improved our daily lives on many levels, it has profoundly raised the quality of life for many. Healthcare is an area that has embraced mobile technology, and while it’s still in the infancy of adoption of this technology, it is already making profound improvements for many. Healthcare providers get a quick medical opinion, through medical apps like this one, or they can review home medical tests from anywhere and make crucial changes to the patient’s care. Medical staff members can receive pacemaker tests remotely using a phone and change the programming of the device to address changes in the patient’s condition. Doctors can see intricate diagnostic images on phones and find conditions that need immediate treatment, all while the patient is comfortable at home. Villagers in third-world countries who have no local healthcare can be diagnosed and have treatment prescribed by distant healthcare providers. Patients in areas experiencing significant problems with counterfeit medications can use a phone at the point of purchase to confirm if a medication is legitimate. This is saving lives and improving healthcare every day for those affected. Children with ailments such as autism are using tablets to help them focus and communicate with those around them. Patients recovering from strokes and brain injuries are using tablets to great effect in their recoveries. Patients of all ages are using mobile devices to communicate with healthcare providers and loved ones as they never could before. People born without hearing are having implants that can be programmed by wireless technology that allows them to hear their children speak for the very first time. Text messaging on phones has made a tremendous impact on communication for the deaf. Diabetics can monitor their glucose level and have it wirelessly transferred to a small insulin pump that injects just the right amount to keep them where they need to be. Blind individuals can use mobile phones to not only improve their lives but also help achieve an incredible level of independence. Not only do these phones speak to the blind so they know what is displayed on the screen, but they also have software that can safely guide them out in busy cities. Mobile technology can help the blind pick out clothes for the day that match. The technology on smartphones can scan the change received from purchase and tell them how much was given.
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Tell me the advantages and disadvantages of smartphones in our lives with one or two sentences for each one. Also give me three examples for healthcare services of smartphones and one example of being dangerous for our lives. We are living in the era of gadgets and smartphones, and communication has never been so easy; with social media, we’re always connected to our friends and millions of other people, no matter where we are. All we need is a smartphone with an internet connection. Mobile phones have become part of our daily lives and besides communication, we have available a vast variety of apps that can make our daily life a lot easier. Though the cost of app development is rising, the number of apps in app stores is increasing. Some of these apps had been optimized for mobile apps stores so that we can find them easier. However, being in the business of making apps, we must question what’s the impact of mobile phones in our lives and society? In this article, we’ll look into what are the positive and negative effects of using mobile phones on a daily basis. Negative effects of mobile phones in our lives 1. Waste of time As much we love what nowadays smartphones can do for us, this technology also has a downside. A recent study from the digital analytic firm Flurry shows that we surprisingly spend on average almost 3-4 hours a day staring at our smart devices, totalizing nearly one day every week! One day, that’s right! 2. Addiction Phones addiction has a name: nomophobia, the fear of being out of cell phone contact. Therefore, not just spending too much time on our devices is a sign of addiction, but the fear of not having them on us as well. Like any other form of addiction, studies show that people that are addicted to their phones often show signs of depression, anxiety, and other forms of mental health problems. 3. Distraction Another study, this time from Florida State University, says that smartphones notifications can impair our concentration, even being short in duration they cause enough of a distraction to affect your ability to focus on a given task, decreasing your performance by prompting task-irrelevant thoughts and mind-wandering. This can be very dangerous in some specific situations, like driving, for instance, a simple notification can cause really serious accidents. 4. Affecting social skills Besides the problems mentioned above, it also has a huge impact on people’s social lives, people are getting more disconnected from the real world, they put their phones ahead of human interaction, it’s getting harder to see people talking to each other in public places, they’re always too busy with their mobile devices, checking notifications, sending messages or just sharing a new video. Our social skills seem to diminish constantly due to the overuse of smartphones and turning us into “smombie”. “Smartphone zombies” or “smombie” regularly cross our ways, perhaps you’re not familiar with the term but most likely you saw one today. They’re the people on public streets and places who walk slowly in peculiar ways with their eyes and fingers focused on your phone display. But it isn’t just road safety at stake here: think about how often they bump into things. The technology that drives mobile devices has improved a lot since they appeared, and especially in the last ten years. Mobile gadgets have gotten smaller, more powerful, and very useful. They are everywhere and play increasingly greater roles in the lives of most everyone. Positive effects of mobile phones in our life 1. Communication Besides the dark part of mobile technology, in the form of phones, tablets, and notebooks, is making our lives better than ever before. It does this in many ways, not the least of which is making communications routine. We can be in touch with those we need to reach, whether work-related or personal in nature. Mobile technology has changed the way we do business for the better. Never have we been able to share so much with friends and family as we can today, and that is in great part due to mobile technology. Without mobile devices and the technology behind them, participation in social networking would never have grown as much as it has. Sharing seemingly trivial information like where we are, what we are doing, and what that looks like significantly impacts our relationships with friends and loved ones. Mobile technology has given a voice to those otherwise cut off from the world during cataclysmic events. That voice can reach out for help when local tragedy strikes, and for the first time, these people are not alone. They can share their plight using mobile communication through text, voice, and, most importantly, images, and bring about real change. 2. Daily utilities Mobile phones have changed the way we live our lives. Now, not only can they help us stay connected with friends and family over social media or talk to someone on a video call without paying for data usage, but they also make everything from booking hotels and cabs to capturing memories easier than ever before thanks to their built-in cameras! We have more information in our hands than at any time in history. It has become second nature to quickly lookup helpful resources for whatever activity we need to do. Our gadgets can even anticipate what information we need and present it to us when it is most useful. 3. Healthcare services While mobile phones has improved our daily lives on many levels, it has profoundly raised the quality of life for many. Healthcare is an area that has embraced mobile technology, and while it’s still in the infancy of adoption of this technology, it is already making profound improvements for many. Healthcare providers get a quick medical opinion, through medical apps like this one, or they can review home medical tests from anywhere and make crucial changes to the patient’s care. Medical staff members can receive pacemaker tests remotely using a phone and change the programming of the device to address changes in the patient’s condition. Doctors can see intricate diagnostic images on phones and find conditions that need immediate treatment, all while the patient is comfortable at home. Villagers in third-world countries who have no local healthcare can be diagnosed and have treatment prescribed by distant healthcare providers. Patients in areas experiencing significant problems with counterfeit medications can use a phone at the point of purchase to confirm if a medication is legitimate. This is saving lives and improving healthcare every day for those affected. Children with ailments such as autism are using tablets to help them focus and communicate with those around them. Patients recovering from strokes and brain injuries are using tablets to great effect in their recoveries. Patients of all ages are using mobile devices to communicate with healthcare providers and loved ones as they never could before. People born without hearing are having implants that can be programmed by wireless technology that allows them to hear their children speak for the very first time. Text messaging on phones has made a tremendous impact on communication for the deaf. Diabetics can monitor their glucose level and have it wirelessly transferred to a small insulin pump that injects just the right amount to keep them where they need to be. Blind individuals can use mobile phones to not only improve their lives but also help achieve an incredible level of independence. Not only do these phones speak to the blind so they know what is displayed on the screen, but they also have software that can safely guide them out in busy cities. Mobile technology can help the blind pick out clothes for the day that match. The technology on smartphones can scan the change received from purchase and tell them how much was given. https://blog.mobiversal.com/the-impact-of-mobile-technology-in-our-daily-life.html
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
We are living in the era of gadgets and smartphones, and communication has never been so easy; with social media, we’re always connected to our friends and millions of other people, no matter where we are. All we need is a smartphone with an internet connection. Mobile phones have become part of our daily lives and besides communication, we have available a vast variety of apps that can make our daily life a lot easier. Though the cost of app development is rising, the number of apps in app stores is increasing. Some of these apps had been optimized for mobile apps stores so that we can find them easier. However, being in the business of making apps, we must question what’s the impact of mobile phones in our lives and society? In this article, we’ll look into what are the positive and negative effects of using mobile phones on a daily basis. Negative effects of mobile phones in our lives 1. Waste of time As much we love what nowadays smartphones can do for us, this technology also has a downside. A recent study from the digital analytic firm Flurry shows that we surprisingly spend on average almost 3-4 hours a day staring at our smart devices, totalizing nearly one day every week! One day, that’s right! 2. Addiction Phones addiction has a name: nomophobia, the fear of being out of cell phone contact. Therefore, not just spending too much time on our devices is a sign of addiction, but the fear of not having them on us as well. Like any other form of addiction, studies show that people that are addicted to their phones often show signs of depression, anxiety, and other forms of mental health problems. 3. Distraction Another study, this time from Florida State University, says that smartphones notifications can impair our concentration, even being short in duration they cause enough of a distraction to affect your ability to focus on a given task, decreasing your performance by prompting task-irrelevant thoughts and mind-wandering. This can be very dangerous in some specific situations, like driving, for instance, a simple notification can cause really serious accidents. 4. Affecting social skills Besides the problems mentioned above, it also has a huge impact on people’s social lives, people are getting more disconnected from the real world, they put their phones ahead of human interaction, it’s getting harder to see people talking to each other in public places, they’re always too busy with their mobile devices, checking notifications, sending messages or just sharing a new video. Our social skills seem to diminish constantly due to the overuse of smartphones and turning us into “smombie”. “Smartphone zombies” or “smombie” regularly cross our ways, perhaps you’re not familiar with the term but most likely you saw one today. They’re the people on public streets and places who walk slowly in peculiar ways with their eyes and fingers focused on your phone display. But it isn’t just road safety at stake here: think about how often they bump into things. The technology that drives mobile devices has improved a lot since they appeared, and especially in the last ten years. Mobile gadgets have gotten smaller, more powerful, and very useful. They are everywhere and play increasingly greater roles in the lives of most everyone. Positive effects of mobile phones in our life 1. Communication Besides the dark part of mobile technology, in the form of phones, tablets, and notebooks, is making our lives better than ever before. It does this in many ways, not the least of which is making communications routine. We can be in touch with those we need to reach, whether work-related or personal in nature. Mobile technology has changed the way we do business for the better. Never have we been able to share so much with friends and family as we can today, and that is in great part due to mobile technology. Without mobile devices and the technology behind them, participation in social networking would never have grown as much as it has. Sharing seemingly trivial information like where we are, what we are doing, and what that looks like significantly impacts our relationships with friends and loved ones. Mobile technology has given a voice to those otherwise cut off from the world during cataclysmic events. That voice can reach out for help when local tragedy strikes, and for the first time, these people are not alone. They can share their plight using mobile communication through text, voice, and, most importantly, images, and bring about real change. 2. Daily utilities Mobile phones have changed the way we live our lives. Now, not only can they help us stay connected with friends and family over social media or talk to someone on a video call without paying for data usage, but they also make everything from booking hotels and cabs to capturing memories easier than ever before thanks to their built-in cameras! We have more information in our hands than at any time in history. It has become second nature to quickly lookup helpful resources for whatever activity we need to do. Our gadgets can even anticipate what information we need and present it to us when it is most useful. 3. Healthcare services While mobile phones has improved our daily lives on many levels, it has profoundly raised the quality of life for many. Healthcare is an area that has embraced mobile technology, and while it’s still in the infancy of adoption of this technology, it is already making profound improvements for many. Healthcare providers get a quick medical opinion, through medical apps like this one, or they can review home medical tests from anywhere and make crucial changes to the patient’s care. Medical staff members can receive pacemaker tests remotely using a phone and change the programming of the device to address changes in the patient’s condition. Doctors can see intricate diagnostic images on phones and find conditions that need immediate treatment, all while the patient is comfortable at home. Villagers in third-world countries who have no local healthcare can be diagnosed and have treatment prescribed by distant healthcare providers. Patients in areas experiencing significant problems with counterfeit medications can use a phone at the point of purchase to confirm if a medication is legitimate. This is saving lives and improving healthcare every day for those affected. Children with ailments such as autism are using tablets to help them focus and communicate with those around them. Patients recovering from strokes and brain injuries are using tablets to great effect in their recoveries. Patients of all ages are using mobile devices to communicate with healthcare providers and loved ones as they never could before. People born without hearing are having implants that can be programmed by wireless technology that allows them to hear their children speak for the very first time. Text messaging on phones has made a tremendous impact on communication for the deaf. Diabetics can monitor their glucose level and have it wirelessly transferred to a small insulin pump that injects just the right amount to keep them where they need to be. Blind individuals can use mobile phones to not only improve their lives but also help achieve an incredible level of independence. Not only do these phones speak to the blind so they know what is displayed on the screen, but they also have software that can safely guide them out in busy cities. Mobile technology can help the blind pick out clothes for the day that match. The technology on smartphones can scan the change received from purchase and tell them how much was given.
USER:
Tell me the advantages and disadvantages of smartphones in our lives with one or two sentences for each one. Also give me three examples for healthcare services of smartphones and one example of being dangerous for our lives.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 38 | 1,273 | null | 235 |
Use only the provided information to generate responses, do not use any information not found within the question and context given.
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What are two trends in Sudan's banking regulations that need to be encouraged in order to make the actual financial stability match the health indicated by the banking system's EM-Z score model results?
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The analysis of the statistical results obtained from the univariate financial ratios model and Ahmed (2003) model indicate that the Sudanese banks are not financially sound. The liquidity ratios show that there has been deterioration in the liquidity position of the banking industry in Sudan. Since banks depend heavily on lending to generate revenues, the shortage in liquidity weakens their financing capability, which in turn negatively affects their earnings. Furthermore, the lack of liquidity may force banks either to sell assets or pay a premium on borrowed funds. The indebtedness measures reveal that banks are highly leveraged and thus are of high risk. This asserts that the banks will find it hard to get further financing from both national and international financial markets. This high credit risk also suggests that the bank is no longer attractive for the depositors. This is confirmed by the deposits structure of banks, which are mainly demand ones. This result is expected because the Marabaha margin, which indicates the return on investment deposits, almost remains fixed at 12% over the period examined and this percentage is far below inflation levels. This explains the shrinkage in investment deposits through time and signalizes the inability of banks to earn satisfactory profits. Additionally, the profitability measures indicate that banks do generate sufficient profits from their operations. Due to the high level of inflation, the bank's managements find it difficult to pay dividends and also secure internal fund to sustain any growth strategy. The turnover financial metrics indicate that the management of banks are inefficient in employing their working capital to generate revenues and are generally not optimizing the utilization of assets. This inefficient use of assets justifies the low level of profitability realized by those banks. The results obtained from the analysis of the depositors’ confidence index indicate that the depositors slightly trust the banks operating in Sudan. This finding is highly expected as the previous studies provide evidence that factors such as slumping economy, turbulent political climate, high inflation, inconsistent policies and regulations, weak transparency, undercapitalization of banks, which are all prevailing in Sudan, negatively affect the confidence of depositors in their banks. This weak trust implies that the depositors are not sure that their banks can safely secure their deposits and thus are skeptical that their banks are able to pay them back their money. The low confidence in banks also indicates that the depositors are doubtful about the competency, integrity and transparency of their banks’ management. Further, the undercapitalization of banks triggers a fear of banks failure and thus loss of depositors’ money. Additionally, the inconsistent and ever-changing government policies, especially the monetary and credit ones, the weak legal and regulatory systems and laws, the deteriorating economic conditions of the country and the political instability and erratic country foreign relationships, signal that banks will suffer from financial difficulties in the near future and initiate a strong tendency towards cash withdrawal from banks. The analysis also shows that the privately-owned banks do not perform better than the government-owned ones. This result may be attributed to the fact that the government-owned banks are supported by the government. That is to say, the government usually injects funds in those banks that are in bad need for financing. The same logic applies for the better performance of the specialized banks as compared to the nonspecialized ones. The specialized banks are highly propped by the government. For instance, the Central bank has decreased the legal monetary reserve required for the banks that provide finance to agricultural, industrial and mineral mining projects, in an attempt to boost exports. With regards to the comparison of the financial health of the foreign banks with that of the national banks, the analysis indicates that the financial health of both groups is similar, which led to the reasoning that the foreign banks have not benefited from their developed expertise, overseas existence and access the international financial market to strengthen their financial positions. The contrary conclusion arrived at by the employment of EM Z-score model that banks operating in Sudan are generally healthy and financially viable may be in the context that, though the banking sector in Sudan is not financially sound, within the near future of two years most of the banks will not be bankrupt. Several practical implications can be derived from the results of this study. To enhance the financial health of banks and boost the level of confidence in them a number of corrective actions need to be taken by banks management as well as regulatory bodies. Enhancing transparency through adopting enforceable comprehensive disclosure measures, imposing corporate governance, strengthening banks’ capitals and lowering operating costs are some suggested corrective actions. Regulators also need to set rules that protect depositors and safeguard their money.
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Use only the provided information to generate responses, do not use any information not found within the question and context given. What are two trends in Sudan's banking regulations that need to be encouraged in order to make the actual financial stability match the health indicated by the banking system's EM-Z score model results? The analysis of the statistical results obtained from the univariate financial ratios model and Ahmed (2003) model indicate that the Sudanese banks are not financially sound. The liquidity ratios show that there has been deterioration in the liquidity position of the banking industry in Sudan. Since banks depend heavily on lending to generate revenues, the shortage in liquidity weakens their financing capability, which in turn negatively affects their earnings. Furthermore, the lack of liquidity may force banks either to sell assets or pay a premium on borrowed funds. The indebtedness measures reveal that banks are highly leveraged and thus are of high risk. This asserts that the banks will find it hard to get further financing from both national and international financial markets. This high credit risk also suggests that the bank is no longer attractive for the depositors. This is confirmed by the deposits structure of banks, which are mainly demand ones. This result is expected because the Marabaha margin, which indicates the return on investment deposits, almost remains fixed at 12% over the period examined and this percentage is far below inflation levels. This explains the shrinkage in investment deposits through time and signalizes the inability of banks to earn satisfactory profits. Additionally, the profitability measures indicate that banks do generate sufficient profits from their operations. Due to the high level of inflation, the bank's managements find it difficult to pay dividends and also secure internal fund to sustain any growth strategy. The turnover financial metrics indicate that the management of banks are inefficient in employing their working capital to generate revenues and are generally not optimizing the utilization of assets. This inefficient use of assets justifies the low level of profitability realized by those banks. The results obtained from the analysis of the depositors’ confidence index indicate that the depositors slightly trust the banks operating in Sudan. This finding is highly expected as the previous studies provide evidence that factors such as slumping economy, turbulent political climate, high inflation, inconsistent policies and regulations, weak transparency, undercapitalization of banks, which are all prevailing in Sudan, negatively affect the confidence of depositors in their banks. This weak trust implies that the depositors are not sure that their banks can safely secure their deposits and thus are skeptical that their banks are able to pay them back their money. The low confidence in banks also indicates that the depositors are doubtful about the competency, integrity and transparency of their banks’ management. Further, the undercapitalization of banks triggers a fear of banks failure and thus loss of depositors’ money. Additionally, the inconsistent and ever-changing government policies, especially the monetary and credit ones, the weak legal and regulatory systems and laws, the deteriorating economic conditions of the country and the political instability and erratic country foreign relationships, signal that banks will suffer from financial difficulties in the near future and initiate a strong tendency towards cash withdrawal from banks. The analysis also shows that the privately-owned banks do not perform better than the government-owned ones. This result may be attributed to the fact that the government-owned banks are supported by the government. That is to say, the government usually injects funds in those banks that are in bad need for financing. The same logic applies for the better performance of the specialized banks as compared to the nonspecialized ones. The specialized banks are highly propped by the government. For instance, the Central bank has decreased the legal monetary reserve required for the banks that provide finance to agricultural, industrial and mineral mining projects, in an attempt to boost exports. With regards to the comparison of the financial health of the foreign banks with that of the national banks, the analysis indicates that the financial health of both groups is similar, which led to the reasoning that the foreign banks have not benefited from their developed expertise, overseas existence and access the international financial market to strengthen their financial positions. The contrary conclusion arrived at by the employment of EM Z-score model that banks operating in Sudan are generally healthy and financially viable may be in the context that, though the banking sector in Sudan is not financially sound, within the near future of two years most of the banks will not be bankrupt. Several practical implications can be derived from the results of this study. To enhance the financial health of banks and boost the level of confidence in them a number of corrective actions need to be taken by banks management as well as regulatory bodies. Enhancing transparency through adopting enforceable comprehensive disclosure measures, imposing corporate governance, strengthening banks’ capitals and lowering operating costs are some suggested corrective actions. Regulators also need to set rules that protect depositors and safeguard their money.
|
Use only the provided information to generate responses, do not use any information not found within the question and context given.
EVIDENCE:
The analysis of the statistical results obtained from the univariate financial ratios model and Ahmed (2003) model indicate that the Sudanese banks are not financially sound. The liquidity ratios show that there has been deterioration in the liquidity position of the banking industry in Sudan. Since banks depend heavily on lending to generate revenues, the shortage in liquidity weakens their financing capability, which in turn negatively affects their earnings. Furthermore, the lack of liquidity may force banks either to sell assets or pay a premium on borrowed funds. The indebtedness measures reveal that banks are highly leveraged and thus are of high risk. This asserts that the banks will find it hard to get further financing from both national and international financial markets. This high credit risk also suggests that the bank is no longer attractive for the depositors. This is confirmed by the deposits structure of banks, which are mainly demand ones. This result is expected because the Marabaha margin, which indicates the return on investment deposits, almost remains fixed at 12% over the period examined and this percentage is far below inflation levels. This explains the shrinkage in investment deposits through time and signalizes the inability of banks to earn satisfactory profits. Additionally, the profitability measures indicate that banks do generate sufficient profits from their operations. Due to the high level of inflation, the bank's managements find it difficult to pay dividends and also secure internal fund to sustain any growth strategy. The turnover financial metrics indicate that the management of banks are inefficient in employing their working capital to generate revenues and are generally not optimizing the utilization of assets. This inefficient use of assets justifies the low level of profitability realized by those banks. The results obtained from the analysis of the depositors’ confidence index indicate that the depositors slightly trust the banks operating in Sudan. This finding is highly expected as the previous studies provide evidence that factors such as slumping economy, turbulent political climate, high inflation, inconsistent policies and regulations, weak transparency, undercapitalization of banks, which are all prevailing in Sudan, negatively affect the confidence of depositors in their banks. This weak trust implies that the depositors are not sure that their banks can safely secure their deposits and thus are skeptical that their banks are able to pay them back their money. The low confidence in banks also indicates that the depositors are doubtful about the competency, integrity and transparency of their banks’ management. Further, the undercapitalization of banks triggers a fear of banks failure and thus loss of depositors’ money. Additionally, the inconsistent and ever-changing government policies, especially the monetary and credit ones, the weak legal and regulatory systems and laws, the deteriorating economic conditions of the country and the political instability and erratic country foreign relationships, signal that banks will suffer from financial difficulties in the near future and initiate a strong tendency towards cash withdrawal from banks. The analysis also shows that the privately-owned banks do not perform better than the government-owned ones. This result may be attributed to the fact that the government-owned banks are supported by the government. That is to say, the government usually injects funds in those banks that are in bad need for financing. The same logic applies for the better performance of the specialized banks as compared to the nonspecialized ones. The specialized banks are highly propped by the government. For instance, the Central bank has decreased the legal monetary reserve required for the banks that provide finance to agricultural, industrial and mineral mining projects, in an attempt to boost exports. With regards to the comparison of the financial health of the foreign banks with that of the national banks, the analysis indicates that the financial health of both groups is similar, which led to the reasoning that the foreign banks have not benefited from their developed expertise, overseas existence and access the international financial market to strengthen their financial positions. The contrary conclusion arrived at by the employment of EM Z-score model that banks operating in Sudan are generally healthy and financially viable may be in the context that, though the banking sector in Sudan is not financially sound, within the near future of two years most of the banks will not be bankrupt. Several practical implications can be derived from the results of this study. To enhance the financial health of banks and boost the level of confidence in them a number of corrective actions need to be taken by banks management as well as regulatory bodies. Enhancing transparency through adopting enforceable comprehensive disclosure measures, imposing corporate governance, strengthening banks’ capitals and lowering operating costs are some suggested corrective actions. Regulators also need to set rules that protect depositors and safeguard their money.
USER:
What are two trends in Sudan's banking regulations that need to be encouraged in order to make the actual financial stability match the health indicated by the banking system's EM-Z score model results?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 21 | 33 | 791 | null | 280 |
The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, "The information is not available at this time."
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When evaluating legacy systems, how do we determine whether to replace or maintain these legacy systems?
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Home > IT applications, infrastructure and operations FEATURE ~ 20F3 4 P Partof: The CIO's guide to legacy systems Replacing vs. maintaining legacy systems Understanding issues such as which systems hinder organizational performance can help IT leaders decide which legacy systems to replace and which to maintain. By Mary K. Pratt Published: 05 Jul 2023 Few CIOs escape the complexity of deciding whether to maintain legacy systems or replace them altogether. The right choice, as with most things in life, is: It depends. IT leaders might want to replace a legacy_system because of outdated hardware, increased security risks or a desire to enable a digital transformation initiative. But replacing existing systems isn't always in the company's best interest. Legacy systems can remain in place if the existing system is reliable. vclo” Q Prioritize a strategic assessment One alternative to completely replacing or maintaining legacy systems is to modernize them. Modernized systems might be more cost-effective, while increasing efficiency and improving existing processes at the same time. Michael Bradshaw is currently working through a multiyear plan to modernize the technology at Kyndryl, a New York-based IT services company. After about two years of planning and execution, the goal is to complete the big moves by November, he said. A strategic assessment of the company's existing systems and applications was the first step in the process. His modernization plan calls for the digitalization of the company's entire business chain, Bradshaw said. Previously, about 1,800 applications supported that chain, but the number should drop to 360 by year's end and eventually down to 300. His IT team partnered with the business to develop a target, as well as a roadmap on how to get there, he said. 20f34 P + The goal of this strategy is to streamline the modernization efforts. Up Next The strategic assessment enabled §Tdasisienliyashaylagaeysysiams laimmeripbiigraationmodriizgtion and which could wait, systems Bradshaw said. Slyingwit i-and-rue logacysysems can el ke Undertanding sses such s which ystr e safot vt Byl as 1o wad changes al a izzying organizatonal perormance can ol " T loax Afocus on competitive advantage heiped Steer the roadmap, foo. -~ el peroma "Ultimately, all the systems we provide are to support the execution of business, so you start with the business needs, what's most important for the business," he said. Organizations that want to modernize must choose systems that support their objectives. The company considered cybersecurity concerns, maintenance requirements and operational costs to determine which apps to prioritize for modernization, Bradshaw said. Replacing vs. maintaining legacy systems Many organizations still rely on legacy systems for some of their workloads, which can limit innovation efforts. Seventy-two percent of all respondents believe that their organization's digital transformation efforts are lagging due to technical debt, while 51% cite a complex legacy IT infrastructure as one of their key challenges over the next year, according to the 2023 report "CIO Pulse: 2023 budgets & priorities” from cloud software provider SoftwareOne, headquartered in Milwaukee. Yet, many CIOs don't always have a well-formulated path forward. A good portion of IT leaders are unclear on what they should modernize first and what legacy systems are OK to keep running. Some might end up shedding a legacy system under duress, said Joe Davey, partner at West Monroe, a digital services firm, headquartered in Chicago. "Often, it takes a catalyzing event," Davey said. In some cases, CIOs replace legacy technologies without a clear strategy in mind. "[The strategy is] technology for technology's sake." he said. “[But] there's a lack of understanding how that technology can help them get ahead.” Although companies eventually need to replace all legacy technology, CIOs don't need to modernize all systems at once - nor is an undertaking of that magnitude usually possible. Instead, CIOs must determine what legacy systems need to be replaced sooner and which can be replaced later, both Davey and Bradshaw said. 5 reasons to replace legacy systems Organizations should carefully evaluate their existing systems before making any changes. IT leaders should understand the following reasons why legacy systems should be prioritized for modernization. 1. The system creates an unacceptable security risk Many IT teams can't patch some legacy systems because vendors don't release new patches. Other systems have significant security. vulnerabilities IT can't address for another reason. Any such system with "security vulnerabiltties that could bring the [organization] to its knees should be a high priority for replacement,” said Dave Powner, executive director of the Center for Data-Driven Policy at Mitre Corp., a nonprofit research and development organization, based in McLean, Va., that provides technical and cybersecurity support to U.S. government agencies. 2. The system hinders the organization’s performance Inefficient systems can cause delays and decreased productivity. 20f34 P + Organizations should prioritize replacing systems that affect efficiency, said Minir Patel, vice president of cloud architecture at Apps Associates, a consultancy augl NP, headquartered in Acton, Mass. 6 reasons legacy systems are stillinuse Replacing vs. maintaining legac Systems by modernizing legacy systems, Powner said. Enterprises can pursue new opportunities or significantly improve mission cap4Biiieé Stying win rec-and-ruo legacy systems can feel ke Understanding issues uch as whih syster 3. The system doesn't fit into the oR§AHIZHESH S ERUFEEsgaoes ot davng organzatona poromancecanhalp I lac Alegacy system without immediate problems can still be a priority for modernization if the processes it supports aren't critical for the organization's long-term goals. When developing a modernization strategy, CIOs should focus on where the company wants to be, said Suneel Ghei, principal research director at Info-Tech Research Group, an IT services management company, based in London, Ont. 4. The system costs too much to maintain Al systems come with run costs. In some cases, a system’s maintenance costs might exceed its business value, including the cost of modernizing the system. Excessive run costs draw resources away from pursuing innovation and new opportunities, Patel said. CIOs need to do that math and know when they're approaching or have gone past that point so they can take appropriate action. 5. The system is at a high risk of failure Systems with no vendor support, that depend on obsolete programming languages or are highly customized with scant documentation and no remaining institutional knowledge of its buildout are highly fragile. Organizations could have a difficult time recovering if the system should fail. For example, some businesses have needed help with IT systems but couldn'tfind IT talent to service the systems. It's best to replace those systems before that happens to ensure business continuity. 3 reasons to maintain legacy systems Companies can maintain legacy systems under the right circumstances. Here are three reasons to maintain a legacy system that IT leaders should understand. 1. The system has an acceptable level of risk Asystem no longer supported by a vendor or built on an obsolete programming language does have security vulnerabilities. But it might not create unnecessary risks. For example, a company might rely on the system for a noncritical back-office function. There would be minimal effects on daily operations if the system failed. Or the CIO might have or could easily access the talent needed to keep it running at a reasonable cost. In such cases, the CIO might reasonably opt to make modernizing that system a lower priority. 2. The system still supports the organization's needs Asystem that meets the organization's needs, while not hindering its ability to pursue new competitive opportunities, is a strong candidate to stay in place. Organizations might do themselves a disservice by replacing legacy systems with modern versions they're not ready to use or optimize, Patel said. For example, replacing an existing system with a modern app featuring Al might seem like a good strategy. Still, a company needs to have the maturity required to use the Al component successfully to get ROI that justifies the modernization. 3. The system's processes can be sunsetted or shifted to other systems 20f34 P + CIOs might opt to keep a legacy system in place if they know that the business processes it supports will be sunsetted by the organization or shifted to other systems, pinie¥itin Naik, technical fellow at Mitre Corp. 6 reasons legacy systems are still inuse Replacing vs. maintaining legac il a system that won't't be needed in the future won'te deliver good ROI® Replacing % Next Steps Stying win rec-and-ruo legacy systems can el ke Ine slest roue. But 3 the wor changes ata dzzying vstems Understanding issues such as whih syster organizatonalperormance can help I eac How to modernize apps as part of the cloud migration process How to perform an application modernization assessment % Dig Deeper on IT applications, infrastructure and operations bimodal IT (bimodal information technology) How to modernize legacy applications By: Linda Tucci By: Mary Pratt IT transformation Defra's tech review reveals legacy IT issues across government By: Brian Holak By: Cliff Saran -ADS BY GOOGLE Latest TechTarget resources Cloud Computing [ Top 6 soft skills in IT that cloud teams need 20f34 P + Softskills play a bigger partin successiul cloud deployments than you might think. Technical skill are obviously essential in . MOBILE COMPUTING Up Next DATACENTER 6 reasons legacy systems a@mfi.msandzmef&%dwsgfi- cloud SUSTAINABILITY AND ESG. Staying with tried-and-lrue legacy systems carStaridieds for ndeeiifiodiirisawes chishgingwith Sheteapid pace of cloud adoption. certificatioreprograms he safest route. But as the world changes al EZisW oxpeRERVERISEARS URBBCEHLBRRIT leac About Us Contributors Guides Editorial Ethics Policy Reprints Opinions Meet The Editors Answers Photo Stories Contact Us Definitions Quizzes Advertisers E-Products Tips Partner with Us Events Tutorials Media Kit Fealures Videos Corporate Site AllRights Reserved, Copyright 2007 - 2024, TechTarget Privacy Policy D0 Not Sel or Share My Persona Information 20f34 P +
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The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, "The information is not available at this time." When evaluating legacy systems, how do we determine whether to replace or maintain these legacy systems? Home > IT applications, infrastructure and operations FEATURE ~ 20F3 4 P Partof: The CIO's guide to legacy systems Replacing vs. maintaining legacy systems Understanding issues such as which systems hinder organizational performance can help IT leaders decide which legacy systems to replace and which to maintain. By Mary K. Pratt Published: 05 Jul 2023 Few CIOs escape the complexity of deciding whether to maintain legacy systems or replace them altogether. The right choice, as with most things in life, is: It depends. IT leaders might want to replace a legacy_system because of outdated hardware, increased security risks or a desire to enable a digital transformation initiative. But replacing existing systems isn't always in the company's best interest. Legacy systems can remain in place if the existing system is reliable. vclo” Q Prioritize a strategic assessment One alternative to completely replacing or maintaining legacy systems is to modernize them. Modernized systems might be more cost-effective, while increasing efficiency and improving existing processes at the same time. Michael Bradshaw is currently working through a multiyear plan to modernize the technology at Kyndryl, a New York-based IT services company. After about two years of planning and execution, the goal is to complete the big moves by November, he said. A strategic assessment of the company's existing systems and applications was the first step in the process. His modernization plan calls for the digitalization of the company's entire business chain, Bradshaw said. Previously, about 1,800 applications supported that chain, but the number should drop to 360 by year's end and eventually down to 300. His IT team partnered with the business to develop a target, as well as a roadmap on how to get there, he said. 20f34 P + The goal of this strategy is to streamline the modernization efforts. Up Next The strategic assessment enabled §Tdasisienliyashaylagaeysysiams laimmeripbiigraationmodriizgtion and which could wait, systems Bradshaw said. Slyingwit i-and-rue logacysysems can el ke Undertanding sses such s which ystr e safot vt Byl as 1o wad changes al a izzying organizatonal perormance can ol " T loax Afocus on competitive advantage heiped Steer the roadmap, foo. -~ el peroma "Ultimately, all the systems we provide are to support the execution of business, so you start with the business needs, what's most important for the business," he said. Organizations that want to modernize must choose systems that support their objectives. The company considered cybersecurity concerns, maintenance requirements and operational costs to determine which apps to prioritize for modernization, Bradshaw said. Replacing vs. maintaining legacy systems Many organizations still rely on legacy systems for some of their workloads, which can limit innovation efforts. Seventy-two percent of all respondents believe that their organization's digital transformation efforts are lagging due to technical debt, while 51% cite a complex legacy IT infrastructure as one of their key challenges over the next year, according to the 2023 report "CIO Pulse: 2023 budgets & priorities” from cloud software provider SoftwareOne, headquartered in Milwaukee. Yet, many CIOs don't always have a well-formulated path forward. A good portion of IT leaders are unclear on what they should modernize first and what legacy systems are OK to keep running. Some might end up shedding a legacy system under duress, said Joe Davey, partner at West Monroe, a digital services firm, headquartered in Chicago. "Often, it takes a catalyzing event," Davey said. In some cases, CIOs replace legacy technologies without a clear strategy in mind. "[The strategy is] technology for technology's sake." he said. “[But] there's a lack of understanding how that technology can help them get ahead.” Although companies eventually need to replace all legacy technology, CIOs don't need to modernize all systems at once - nor is an undertaking of that magnitude usually possible. Instead, CIOs must determine what legacy systems need to be replaced sooner and which can be replaced later, both Davey and Bradshaw said. 5 reasons to replace legacy systems Organizations should carefully evaluate their existing systems before making any changes. IT leaders should understand the following reasons why legacy systems should be prioritized for modernization. 1. The system creates an unacceptable security risk Many IT teams can't patch some legacy systems because vendors don't release new patches. Other systems have significant security. vulnerabilities IT can't address for another reason. Any such system with "security vulnerabiltties that could bring the [organization] to its knees should be a high priority for replacement,” said Dave Powner, executive director of the Center for Data-Driven Policy at Mitre Corp., a nonprofit research and development organization, based in McLean, Va., that provides technical and cybersecurity support to U.S. government agencies. 2. The system hinders the organization’s performance Inefficient systems can cause delays and decreased productivity. 20f34 P + Organizations should prioritize replacing systems that affect efficiency, said Minir Patel, vice president of cloud architecture at Apps Associates, a consultancy augl NP, headquartered in Acton, Mass. 6 reasons legacy systems are stillinuse Replacing vs. maintaining legac Systems by modernizing legacy systems, Powner said. Enterprises can pursue new opportunities or significantly improve mission cap4Biiieé Stying win rec-and-ruo legacy systems can feel ke Understanding issues uch as whih syster 3. The system doesn't fit into the oR§AHIZHESH S ERUFEEsgaoes ot davng organzatona poromancecanhalp I lac Alegacy system without immediate problems can still be a priority for modernization if the processes it supports aren't critical for the organization's long-term goals. When developing a modernization strategy, CIOs should focus on where the company wants to be, said Suneel Ghei, principal research director at Info-Tech Research Group, an IT services management company, based in London, Ont. 4. The system costs too much to maintain Al systems come with run costs. In some cases, a system’s maintenance costs might exceed its business value, including the cost of modernizing the system. Excessive run costs draw resources away from pursuing innovation and new opportunities, Patel said. CIOs need to do that math and know when they're approaching or have gone past that point so they can take appropriate action. 5. The system is at a high risk of failure Systems with no vendor support, that depend on obsolete programming languages or are highly customized with scant documentation and no remaining institutional knowledge of its buildout are highly fragile. Organizations could have a difficult time recovering if the system should fail. For example, some businesses have needed help with IT systems but couldn'tfind IT talent to service the systems. It's best to replace those systems before that happens to ensure business continuity. 3 reasons to maintain legacy systems Companies can maintain legacy systems under the right circumstances. Here are three reasons to maintain a legacy system that IT leaders should understand. 1. The system has an acceptable level of risk Asystem no longer supported by a vendor or built on an obsolete programming language does have security vulnerabilities. But it might not create unnecessary risks. For example, a company might rely on the system for a noncritical back-office function. There would be minimal effects on daily operations if the system failed. Or the CIO might have or could easily access the talent needed to keep it running at a reasonable cost. In such cases, the CIO might reasonably opt to make modernizing that system a lower priority. 2. The system still supports the organization's needs Asystem that meets the organization's needs, while not hindering its ability to pursue new competitive opportunities, is a strong candidate to stay in place. Organizations might do themselves a disservice by replacing legacy systems with modern versions they're not ready to use or optimize, Patel said. For example, replacing an existing system with a modern app featuring Al might seem like a good strategy. Still, a company needs to have the maturity required to use the Al component successfully to get ROI that justifies the modernization. 3. The system's processes can be sunsetted or shifted to other systems 20f34 P + CIOs might opt to keep a legacy system in place if they know that the business processes it supports will be sunsetted by the organization or shifted to other systems, pinie¥itin Naik, technical fellow at Mitre Corp. 6 reasons legacy systems are still inuse Replacing vs. maintaining legac il a system that won't't be needed in the future won'te deliver good ROI® Replacing % Next Steps Stying win rec-and-ruo legacy systems can el ke Ine slest roue. But 3 the wor changes ata dzzying vstems Understanding issues such as whih syster organizatonalperormance can help I eac How to modernize apps as part of the cloud migration process How to perform an application modernization assessment % Dig Deeper on IT applications, infrastructure and operations bimodal IT (bimodal information technology) How to modernize legacy applications By: Linda Tucci By: Mary Pratt IT transformation Defra's tech review reveals legacy IT issues across government By: Brian Holak By: Cliff Saran -ADS BY GOOGLE Latest TechTarget resources Cloud Computing [ Top 6 soft skills in IT that cloud teams need 20f34 P + Softskills play a bigger partin successiul cloud deployments than you might think. Technical skill are obviously essential in . MOBILE COMPUTING Up Next DATACENTER 6 reasons legacy systems a@mfi.msandzmef&%dwsgfi- cloud SUSTAINABILITY AND ESG. Staying with tried-and-lrue legacy systems carStaridieds for ndeeiifiodiirisawes chishgingwith Sheteapid pace of cloud adoption. certificatioreprograms he safest route. But as the world changes al EZisW oxpeRERVERISEARS URBBCEHLBRRIT leac About Us Contributors Guides Editorial Ethics Policy Reprints Opinions Meet The Editors Answers Photo Stories Contact Us Definitions Quizzes Advertisers E-Products Tips Partner with Us Events Tutorials Media Kit Fealures Videos Corporate Site AllRights Reserved, Copyright 2007 - 2024, TechTarget Privacy Policy D0 Not Sel or Share My Persona Information 20f34 P +
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The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, "The information is not available at this time."
EVIDENCE:
Home > IT applications, infrastructure and operations FEATURE ~ 20F3 4 P Partof: The CIO's guide to legacy systems Replacing vs. maintaining legacy systems Understanding issues such as which systems hinder organizational performance can help IT leaders decide which legacy systems to replace and which to maintain. By Mary K. Pratt Published: 05 Jul 2023 Few CIOs escape the complexity of deciding whether to maintain legacy systems or replace them altogether. The right choice, as with most things in life, is: It depends. IT leaders might want to replace a legacy_system because of outdated hardware, increased security risks or a desire to enable a digital transformation initiative. But replacing existing systems isn't always in the company's best interest. Legacy systems can remain in place if the existing system is reliable. vclo” Q Prioritize a strategic assessment One alternative to completely replacing or maintaining legacy systems is to modernize them. Modernized systems might be more cost-effective, while increasing efficiency and improving existing processes at the same time. Michael Bradshaw is currently working through a multiyear plan to modernize the technology at Kyndryl, a New York-based IT services company. After about two years of planning and execution, the goal is to complete the big moves by November, he said. A strategic assessment of the company's existing systems and applications was the first step in the process. His modernization plan calls for the digitalization of the company's entire business chain, Bradshaw said. Previously, about 1,800 applications supported that chain, but the number should drop to 360 by year's end and eventually down to 300. His IT team partnered with the business to develop a target, as well as a roadmap on how to get there, he said. 20f34 P + The goal of this strategy is to streamline the modernization efforts. Up Next The strategic assessment enabled §Tdasisienliyashaylagaeysysiams laimmeripbiigraationmodriizgtion and which could wait, systems Bradshaw said. Slyingwit i-and-rue logacysysems can el ke Undertanding sses such s which ystr e safot vt Byl as 1o wad changes al a izzying organizatonal perormance can ol " T loax Afocus on competitive advantage heiped Steer the roadmap, foo. -~ el peroma "Ultimately, all the systems we provide are to support the execution of business, so you start with the business needs, what's most important for the business," he said. Organizations that want to modernize must choose systems that support their objectives. The company considered cybersecurity concerns, maintenance requirements and operational costs to determine which apps to prioritize for modernization, Bradshaw said. Replacing vs. maintaining legacy systems Many organizations still rely on legacy systems for some of their workloads, which can limit innovation efforts. Seventy-two percent of all respondents believe that their organization's digital transformation efforts are lagging due to technical debt, while 51% cite a complex legacy IT infrastructure as one of their key challenges over the next year, according to the 2023 report "CIO Pulse: 2023 budgets & priorities” from cloud software provider SoftwareOne, headquartered in Milwaukee. Yet, many CIOs don't always have a well-formulated path forward. A good portion of IT leaders are unclear on what they should modernize first and what legacy systems are OK to keep running. Some might end up shedding a legacy system under duress, said Joe Davey, partner at West Monroe, a digital services firm, headquartered in Chicago. "Often, it takes a catalyzing event," Davey said. In some cases, CIOs replace legacy technologies without a clear strategy in mind. "[The strategy is] technology for technology's sake." he said. “[But] there's a lack of understanding how that technology can help them get ahead.” Although companies eventually need to replace all legacy technology, CIOs don't need to modernize all systems at once - nor is an undertaking of that magnitude usually possible. Instead, CIOs must determine what legacy systems need to be replaced sooner and which can be replaced later, both Davey and Bradshaw said. 5 reasons to replace legacy systems Organizations should carefully evaluate their existing systems before making any changes. IT leaders should understand the following reasons why legacy systems should be prioritized for modernization. 1. The system creates an unacceptable security risk Many IT teams can't patch some legacy systems because vendors don't release new patches. Other systems have significant security. vulnerabilities IT can't address for another reason. Any such system with "security vulnerabiltties that could bring the [organization] to its knees should be a high priority for replacement,” said Dave Powner, executive director of the Center for Data-Driven Policy at Mitre Corp., a nonprofit research and development organization, based in McLean, Va., that provides technical and cybersecurity support to U.S. government agencies. 2. The system hinders the organization’s performance Inefficient systems can cause delays and decreased productivity. 20f34 P + Organizations should prioritize replacing systems that affect efficiency, said Minir Patel, vice president of cloud architecture at Apps Associates, a consultancy augl NP, headquartered in Acton, Mass. 6 reasons legacy systems are stillinuse Replacing vs. maintaining legac Systems by modernizing legacy systems, Powner said. Enterprises can pursue new opportunities or significantly improve mission cap4Biiieé Stying win rec-and-ruo legacy systems can feel ke Understanding issues uch as whih syster 3. The system doesn't fit into the oR§AHIZHESH S ERUFEEsgaoes ot davng organzatona poromancecanhalp I lac Alegacy system without immediate problems can still be a priority for modernization if the processes it supports aren't critical for the organization's long-term goals. When developing a modernization strategy, CIOs should focus on where the company wants to be, said Suneel Ghei, principal research director at Info-Tech Research Group, an IT services management company, based in London, Ont. 4. The system costs too much to maintain Al systems come with run costs. In some cases, a system’s maintenance costs might exceed its business value, including the cost of modernizing the system. Excessive run costs draw resources away from pursuing innovation and new opportunities, Patel said. CIOs need to do that math and know when they're approaching or have gone past that point so they can take appropriate action. 5. The system is at a high risk of failure Systems with no vendor support, that depend on obsolete programming languages or are highly customized with scant documentation and no remaining institutional knowledge of its buildout are highly fragile. Organizations could have a difficult time recovering if the system should fail. For example, some businesses have needed help with IT systems but couldn'tfind IT talent to service the systems. It's best to replace those systems before that happens to ensure business continuity. 3 reasons to maintain legacy systems Companies can maintain legacy systems under the right circumstances. Here are three reasons to maintain a legacy system that IT leaders should understand. 1. The system has an acceptable level of risk Asystem no longer supported by a vendor or built on an obsolete programming language does have security vulnerabilities. But it might not create unnecessary risks. For example, a company might rely on the system for a noncritical back-office function. There would be minimal effects on daily operations if the system failed. Or the CIO might have or could easily access the talent needed to keep it running at a reasonable cost. In such cases, the CIO might reasonably opt to make modernizing that system a lower priority. 2. The system still supports the organization's needs Asystem that meets the organization's needs, while not hindering its ability to pursue new competitive opportunities, is a strong candidate to stay in place. Organizations might do themselves a disservice by replacing legacy systems with modern versions they're not ready to use or optimize, Patel said. For example, replacing an existing system with a modern app featuring Al might seem like a good strategy. Still, a company needs to have the maturity required to use the Al component successfully to get ROI that justifies the modernization. 3. The system's processes can be sunsetted or shifted to other systems 20f34 P + CIOs might opt to keep a legacy system in place if they know that the business processes it supports will be sunsetted by the organization or shifted to other systems, pinie¥itin Naik, technical fellow at Mitre Corp. 6 reasons legacy systems are still inuse Replacing vs. maintaining legac il a system that won't't be needed in the future won'te deliver good ROI® Replacing % Next Steps Stying win rec-and-ruo legacy systems can el ke Ine slest roue. But 3 the wor changes ata dzzying vstems Understanding issues such as whih syster organizatonalperormance can help I eac How to modernize apps as part of the cloud migration process How to perform an application modernization assessment % Dig Deeper on IT applications, infrastructure and operations bimodal IT (bimodal information technology) How to modernize legacy applications By: Linda Tucci By: Mary Pratt IT transformation Defra's tech review reveals legacy IT issues across government By: Brian Holak By: Cliff Saran -ADS BY GOOGLE Latest TechTarget resources Cloud Computing [ Top 6 soft skills in IT that cloud teams need 20f34 P + Softskills play a bigger partin successiul cloud deployments than you might think. Technical skill are obviously essential in . MOBILE COMPUTING Up Next DATACENTER 6 reasons legacy systems a@mfi.msandzmef&%dwsgfi- cloud SUSTAINABILITY AND ESG. Staying with tried-and-lrue legacy systems carStaridieds for ndeeiifiodiirisawes chishgingwith Sheteapid pace of cloud adoption. certificatioreprograms he safest route. But as the world changes al EZisW oxpeRERVERISEARS URBBCEHLBRRIT leac About Us Contributors Guides Editorial Ethics Policy Reprints Opinions Meet The Editors Answers Photo Stories Contact Us Definitions Quizzes Advertisers E-Products Tips Partner with Us Events Tutorials Media Kit Fealures Videos Corporate Site AllRights Reserved, Copyright 2007 - 2024, TechTarget Privacy Policy D0 Not Sel or Share My Persona Information 20f34 P +
USER:
When evaluating legacy systems, how do we determine whether to replace or maintain these legacy systems?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 41 | 16 | 1,603 | null | 153 |
Answer the question by using only information extracted from the context block. Do not use your own knowledge or outside sources of information. If you can't answer the question with information extracted from the context block only, output 'I can't answer due to lack of context'.
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How does lowering the search costs in digital markets impact the price competition of online retailers?
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Reducing Search Costs For Buyers and Sellers Buyers face search costs in obtaining and processing information about the prices and product features of seller offerings. These costs include the opportunity cost of time spent searching, as well as associated expenditures such as driving, telephone calls, computer fees, and magazine subscriptions. Similarly, sellers face search costs in identifying qualified buyers for their products, such as market research, advertising, and sales calls Several Internet-based technologies lower buyer search costs. Many sites help buyers identify appropriate seller offerings: for example, search engines like Alta Vista, Yahoo!, or Google.com; business directories like the one provided by Yahoo!; or specialized product and price comparison agents for specific markets, such as Pricewatch and Computer ESP for computers and components, Expedia and Travelocity for airline tickets and other travel products, Shopper.com and Yahoo Shopping for electronics, and Dealtime for books and music. Online agents like the one provided by R-U-Sure.com monitor consumer behavior and help buyers identify the most desirable prices and product offerings without requiring them to take specific action. Internet technology can also lower the cost to buyers of acquiring information about the reputations of market participants. Such reputations may be provided as part of the marketplace (for example, on eBay), or through specialized intermediaries, such as Bizrate, which rates retailers on specific attributes (like service, product quality, and delivery promptness) by surveying consumers who have recently purchased products from these retailers. The Internet lowers seller search costs as well, by allowing sellers to communicate product information cost-effectively to potential buyers, and by offering sellers new ways to reach buyers through targeted advertising and one-on-one marketing. By reducing search costs on both sides of the market, it appears likely that buyers will be able to consider more product offerings and will identify and purchase products that better match their needs, with a resulting increase in economic efficiency. But the reduction in search costs combined with new capabilities of information technology can set off more complex market dynamics, too. The Impact of Lower Search and Information Costs on Market Competition It may seem clear that lower search and information costs should push markets toward a greater degree of price competition, and this outcome is certainly plausible, especially for homogeneous goods. On the other hand, online retailers can use Internet technology to provide differentiated and customized products, and thus avoid competing purely on price. I will explore these possibilities in turn. The Benefits to Buyers of Greater Price Competition Lower search costs in digital markets will make it easier for buyers to find low-cost sellers, and thus will promote price competition among sellers. This effect will be most pronounced in commodity markets, where lowering buyers’ search costs may result in intensive price competition, wiping out any extraordinary seller profits. It may also be significant in markets where products are differentiated, reducing the monopoly power enjoyed by sellers and leading to lower seller profits while increasing efficiency and total welfare (Bakos, 1997). Some online markets may have lower barriers to entry or smaller efficient scales, thus leading to a larger number of sellers at equilibrium, and correspondingly lower prices and profits. In particular, certain small-scale sellers may have a brighter future in a wired world if they can identify appropriate niches, because they can more easily be searched for and discovered, as search costs online are less determined by geography. It may thus be expected that online markets will have more intense price competition, resulting in lower profits as well as the passing to consumers of savings from lower cost structures. For instance, online shoppers may expect a 20 to 30 percent discount for items normally priced $30-500 (Tedeschi, 1999).
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Answer the question by using only information extracted from the context block. Do not use your own knowledge or outside sources of information. If you can't answer the question with information extracted from the context block only, output 'I can't answer due to lack of context'. Reducing Search Costs For Buyers and Sellers Buyers face search costs in obtaining and processing information about the prices and product features of seller offerings. These costs include the opportunity cost of time spent searching, as well as associated expenditures such as driving, telephone calls, computer fees, and magazine subscriptions. Similarly, sellers face search costs in identifying qualified buyers for their products, such as market research, advertising, and sales calls Several Internet-based technologies lower buyer search costs. Many sites help buyers identify appropriate seller offerings: for example, search engines like Alta Vista, Yahoo!, or Google.com; business directories like the one provided by Yahoo!; or specialized product and price comparison agents for specific markets, such as Pricewatch and Computer ESP for computers and components, Expedia and Travelocity for airline tickets and other travel products, Shopper.com and Yahoo Shopping for electronics, and Dealtime for books and music. Online agents like the one provided by R-U-Sure.com monitor consumer behavior and help buyers identify the most desirable prices and product offerings without requiring them to take specific action. Internet technology can also lower the cost to buyers of acquiring information about the reputations of market participants. Such reputations may be provided as part of the marketplace (for example, on eBay), or through specialized intermediaries, such as Bizrate, which rates retailers on specific attributes (like service, product quality, and delivery promptness) by surveying consumers who have recently purchased products from these retailers. The Internet lowers seller search costs as well, by allowing sellers to communicate product information cost-effectively to potential buyers, and by offering sellers new ways to reach buyers through targeted advertising and one-on-one marketing. By reducing search costs on both sides of the market, it appears likely that buyers will be able to consider more product offerings and will identify and purchase products that better match their needs, with a resulting increase in economic efficiency. But the reduction in search costs combined with new capabilities of information technology can set off more complex market dynamics, too. The Impact of Lower Search and Information Costs on Market Competition It may seem clear that lower search and information costs should push markets toward a greater degree of price competition, and this outcome is certainly plausible, especially for homogeneous goods. On the other hand, online retailers can use Internet technology to provide differentiated and customized products, and thus avoid competing purely on price. I will explore these possibilities in turn. The Benefits to Buyers of Greater Price Competition Lower search costs in digital markets will make it easier for buyers to find low-cost sellers, and thus will promote price competition among sellers. This effect will be most pronounced in commodity markets, where lowering buyers’ search costs may result in intensive price competition, wiping out any extraordinary seller profits. It may also be significant in markets where products are differentiated, reducing the monopoly power enjoyed by sellers and leading to lower seller profits while increasing efficiency and total welfare (Bakos, 1997). Some online markets may have lower barriers to entry or smaller efficient scales, thus leading to a larger number of sellers at equilibrium, and correspondingly lower prices and profits. In particular, certain small-scale sellers may have a brighter future in a wired world if they can identify appropriate niches, because they can more easily be searched for and discovered, as search costs online are less determined by geography. It may thus be expected that online markets will have more intense price competition, resulting in lower profits as well as the passing to consumers of savings from lower cost structures. For instance, online shoppers may expect a 20 to 30 percent discount for items normally priced $30-500 (Tedeschi, 1999). How does lowering the search costs in digital markets impact the price competition of online retailers?
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Answer the question by using only information extracted from the context block. Do not use your own knowledge or outside sources of information. If you can't answer the question with information extracted from the context block only, output 'I can't answer due to lack of context'.
EVIDENCE:
Reducing Search Costs For Buyers and Sellers Buyers face search costs in obtaining and processing information about the prices and product features of seller offerings. These costs include the opportunity cost of time spent searching, as well as associated expenditures such as driving, telephone calls, computer fees, and magazine subscriptions. Similarly, sellers face search costs in identifying qualified buyers for their products, such as market research, advertising, and sales calls Several Internet-based technologies lower buyer search costs. Many sites help buyers identify appropriate seller offerings: for example, search engines like Alta Vista, Yahoo!, or Google.com; business directories like the one provided by Yahoo!; or specialized product and price comparison agents for specific markets, such as Pricewatch and Computer ESP for computers and components, Expedia and Travelocity for airline tickets and other travel products, Shopper.com and Yahoo Shopping for electronics, and Dealtime for books and music. Online agents like the one provided by R-U-Sure.com monitor consumer behavior and help buyers identify the most desirable prices and product offerings without requiring them to take specific action. Internet technology can also lower the cost to buyers of acquiring information about the reputations of market participants. Such reputations may be provided as part of the marketplace (for example, on eBay), or through specialized intermediaries, such as Bizrate, which rates retailers on specific attributes (like service, product quality, and delivery promptness) by surveying consumers who have recently purchased products from these retailers. The Internet lowers seller search costs as well, by allowing sellers to communicate product information cost-effectively to potential buyers, and by offering sellers new ways to reach buyers through targeted advertising and one-on-one marketing. By reducing search costs on both sides of the market, it appears likely that buyers will be able to consider more product offerings and will identify and purchase products that better match their needs, with a resulting increase in economic efficiency. But the reduction in search costs combined with new capabilities of information technology can set off more complex market dynamics, too. The Impact of Lower Search and Information Costs on Market Competition It may seem clear that lower search and information costs should push markets toward a greater degree of price competition, and this outcome is certainly plausible, especially for homogeneous goods. On the other hand, online retailers can use Internet technology to provide differentiated and customized products, and thus avoid competing purely on price. I will explore these possibilities in turn. The Benefits to Buyers of Greater Price Competition Lower search costs in digital markets will make it easier for buyers to find low-cost sellers, and thus will promote price competition among sellers. This effect will be most pronounced in commodity markets, where lowering buyers’ search costs may result in intensive price competition, wiping out any extraordinary seller profits. It may also be significant in markets where products are differentiated, reducing the monopoly power enjoyed by sellers and leading to lower seller profits while increasing efficiency and total welfare (Bakos, 1997). Some online markets may have lower barriers to entry or smaller efficient scales, thus leading to a larger number of sellers at equilibrium, and correspondingly lower prices and profits. In particular, certain small-scale sellers may have a brighter future in a wired world if they can identify appropriate niches, because they can more easily be searched for and discovered, as search costs online are less determined by geography. It may thus be expected that online markets will have more intense price competition, resulting in lower profits as well as the passing to consumers of savings from lower cost structures. For instance, online shoppers may expect a 20 to 30 percent discount for items normally priced $30-500 (Tedeschi, 1999).
USER:
How does lowering the search costs in digital markets impact the price competition of online retailers?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 46 | 16 | 612 | null | 793 |
Respond using only information provided. Do not use any external knowledge or information.
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Assume I just bought this product. How do I use it?
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WARNINGS Read the instructions carefully as they contain important information about safety, use and maintenance of the product. IMPORTANT: READ THIS MANUAL THOROUGHLY AND KEEP IT WITH CARE FOR FUTURE REFERENCE. • These instructions are an integral part of the product and, throughout the entire life of the product, must be kept and be available. The documentation should be given to the subsequent owners of the product. • Attention: this coff ee maker requires a heat source for its operation and develops pressure inside. Failure to comply with the instructions may cause the risk of burn or the coff ee maker burst. • Before each use, make sure the coff ee maker is not damaged and is complete with all its parts. In case of doubts, contact the dealer or the manufacturer. • Remove the packaging materials of the coff ee maker and any warning inside it before use. • This appliance is not intended for use by persons (including children) with reduced physical, sensory or mental capabilities, or lack of experience and knowledge. • Keep out of reach of children. • Use the coff ee maker for the purpose that it was designed for. The product is intended for household use only. • Do not leave the appliance unattended during operation. • Do not touch the hot surface of the coff ee maker. The surfaces get hot, therefore use the handle (1) to move the coff ee maker. • Never use the coff ee maker without water in the heater. • Never use other liquids in the heater or the upper part, the coff ee maker is intended to be used with water only. • The coff ee maker is designed to be used only with water and ground coff ee for Moka for household use: do not use other products (e.g. barley, cocoa, coff ee extracts, tea, COFFEE FOR PERCOLATING FILTERS OR ESPRESSO MACHINES, etc.). • Make sure the steam jet is oriented far from the user, by ensuring the safety valve is not oriented towards the user. • Do not leave the coff ee maker on the heat source for too long to prevent any change in colour. • Make sure the coff ee maker is properly closed before use. • When using a gas heat source, the fl ame must not go beyond the rim of the heater. • In case of induction/electric/ceramic glass plate, never use the highest heat, but maintain a medium setting. In case of induction plate, never use the boost function. • Do not open or close the coff ee maker by forcing the column (1). • Never use the coff ee maker in the oven or in a microwave. • During use, close the cup support base (7) of the coff ee maker. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. • After use, allow the coff ee maker to cool down before opening it. • After use, place the coff ee maker on suitable surfaces, as its base reaches high temperatures. Do not store it in contact with fl ammable surfaces that might deteriorate with the heat. • Choose only original Bialetti spare parts suitable for the model used. • At the end of dispensing there might be some water in the heater. Such residue helps avoid possible changes in colour of the heater surface in case the coff ee maker is left on the heat source for a prolonged period of time after dispensing. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. INSTRUCTIONS FOR USE First use of the product • When using the coff ee maker for the fi rst time, wash it thoroughly, only with water, and make at least 3 cups of coff ee, discarding them (do not drink them). • For the use on induction, check the compatibility of the diameter of the coff ee maker heater with the technical features of the hob. • Check the coff ee maker is complete with all its components and is properly positioned, as shown in the fi gure. Check the coff ee maker is complete with safety valve, funnel fi lter, gasket and fi lter plate and that these parts are in the correct position (5-6-3-2). • Do not drink the fi rst 3 dispensing operations of coff ee as they are necessary for enhancing the aroma of coff ee at best. • Make sure the safety valve is not oriented towards the user. • Hand wash only without using detergents and abrasive sponges to preserve its features over the time. • Use ground coff ee for Moka, that is with a suitable grinding, and never use fi ne grinding coff ee. • Never press coff ee into the funnel. • Store each part of the coff ee maker completely dry and without closing it. • Replace the gasket, if worn. It is recommended to replace it at least once a year anyway. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, jeopardizing a proper sealing. MAKING COFFEE 1. Remove the cup support base (7 - upper part of the coff ee maker) and, without forcing the column (1), rotate clockwise the heater (4 - lower part of the coff ee maker) Fig. A. 2. Fill the heater (4) with cold water without exceeding the opening of the safety valve level (Fig. B). 3. Insert the funnel fi lter (6) into the heater (4). Fig. C. 4. Fill the funnel fi lter (6) with ground coff ee for Moka, without pressing it down, taking care not to leave coff ee powder on the rim of the coff ee maker, Fig. D. 5. Assemble the cup support base (7) on the heater (4), by rotating the heater counterclockwise, and tighten well, without pressing too much and avoiding to force the column (1), Fig. E. 6. Put the coff ee maker on the heat source with the cups underneath the column (1) on the cup support base (7), Fig.F. In case of fl ame, make sure that it does not go beyond the rim of the coff ee maker. In case of induction/ electric/ceramic glass plate, do not use the highest heat. BIALETTI INSPECTION SAFETY VALVE (5) The Bialetti valve has been patented and designed to guarantee the use of the coff ee maker in complete safety. Using the coff ee maker with drinking water might entail the risk of formation of lime scale in the hole of the valve, causing its clogging. To avoid clogging arising from lime scale, just move the small piston coming out of the valve along its axis during the normal washing operations, Fig. F. It is advisable to carry out this inspection periodically to ensure its proper operation. The safety valve is a protective element and should intervene only in conditions of abnormal operation or use of the coff ee maker. CLEANING AND MAINTENANCE • Before carrying out cleaning and maintenance, wait for the appliance to cool down completely. • It is advisable to clean the coff ee maker in all its parts on a regular basis, including the dispensing column, which must be free from coff ee powder obstructions. • After each use, wash with warm water without detergents and/or abrasive materials (the product CANNOT be put in the dishwasher). • Store the product perfectly dry in all its parts and not closed to prevent any build-up of stains/oxidations. • Regularly perform the decalcifi cation procedure: 1. Fill the heater with water as per normal preparation. 2. Add two teaspoons of citric acid or vinegar. 3. Reassemble the product and, without adding any coff ee powder, dispense once. 4. Throw away the solution obtained. 5. Wash the coff ee maker under running water and make coff ee. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, avoiding a proper sealing. • Regularly check that the holes of the fi lter plate (2) are not obstructed, otherwise open them using a brush with delicate bristles or a needle. • Periodically check the internal components and, in case of wearing or damage, replace them only with original Bialetti spare parts suitable for the model used. • Replace the gasket (3), if worn. It is advisable to replace it at least once a • At the end of the life of the product, dispose it in a waste collection centre. • The adequate waste sorting and the correct disposal contribute to avoid negative impacts on the environment and public health and permit recycling of the materials which the product is made of. • For more detailed information regarding the available collection systems, contract the local refuse centre or the store where the product was purchased.
|
Assume I just bought this product. How do I use it? Respond using only information provided. Do not use any external knowledge or information. WARNINGS Read the instructions carefully as they contain important information about safety, use and maintenance of the product. IMPORTANT: READ THIS MANUAL THOROUGHLY AND KEEP IT WITH CARE FOR FUTURE REFERENCE. • These instructions are an integral part of the product and, throughout the entire life of the product, must be kept and be available. The documentation should be given to the subsequent owners of the product. • Attention: this coff ee maker requires a heat source for its operation and develops pressure inside. Failure to comply with the instructions may cause the risk of burn or the coff ee maker burst. • Before each use, make sure the coff ee maker is not damaged and is complete with all its parts. In case of doubts, contact the dealer or the manufacturer. • Remove the packaging materials of the coff ee maker and any warning inside it before use. • This appliance is not intended for use by persons (including children) with reduced physical, sensory or mental capabilities, or lack of experience and knowledge. • Keep out of reach of children. • Use the coff ee maker for the purpose that it was designed for. The product is intended for household use only. • Do not leave the appliance unattended during operation. • Do not touch the hot surface of the coff ee maker. The surfaces get hot, therefore use the handle (1) to move the coff ee maker. • Never use the coff ee maker without water in the heater. • Never use other liquids in the heater or the upper part, the coff ee maker is intended to be used with water only. • The coff ee maker is designed to be used only with water and ground coff ee for Moka for household use: do not use other products (e.g. barley, cocoa, coff ee extracts, tea, COFFEE FOR PERCOLATING FILTERS OR ESPRESSO MACHINES, etc.). • Make sure the steam jet is oriented far from the user, by ensuring the safety valve is not oriented towards the user. • Do not leave the coff ee maker on the heat source for too long to prevent any change in colour. • Make sure the coff ee maker is properly closed before use. • When using a gas heat source, the fl ame must not go beyond the rim of the heater. • In case of induction/electric/ceramic glass plate, never use the highest heat, but maintain a medium setting. In case of induction plate, never use the boost function. • Do not open or close the coff ee maker by forcing the column (1). • Never use the coff ee maker in the oven or in a microwave. • During use, close the cup support base (7) of the coff ee maker. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. • After use, allow the coff ee maker to cool down before opening it. • After use, place the coff ee maker on suitable surfaces, as its base reaches high temperatures. Do not store it in contact with fl ammable surfaces that might deteriorate with the heat. • Choose only original Bialetti spare parts suitable for the model used. • At the end of dispensing there might be some water in the heater. Such residue helps avoid possible changes in colour of the heater surface in case the coff ee maker is left on the heat source for a prolonged period of time after dispensing. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. INSTRUCTIONS FOR USE First use of the product • When using the coff ee maker for the fi rst time, wash it thoroughly, only with water, and make at least 3 cups of coff ee, discarding them (do not drink them). • For the use on induction, check the compatibility of the diameter of the coff ee maker heater with the technical features of the hob. • Check the coff ee maker is complete with all its components and is properly positioned, as shown in the fi gure. Check the coff ee maker is complete with safety valve, funnel fi lter, gasket and fi lter plate and that these parts are in the correct position (5-6-3-2). • Do not drink the fi rst 3 dispensing operations of coff ee as they are necessary for enhancing the aroma of coff ee at best. • Make sure the safety valve is not oriented towards the user. • Hand wash only without using detergents and abrasive sponges to preserve its features over the time. • Use ground coff ee for Moka, that is with a suitable grinding, and never use fi ne grinding coff ee. • Never press coff ee into the funnel. • Store each part of the coff ee maker completely dry and without closing it. • Replace the gasket, if worn. It is recommended to replace it at least once a year anyway. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, jeopardizing a proper sealing. MAKING COFFEE 1. Remove the cup support base (7 - upper part of the coff ee maker) and, without forcing the column (1), rotate clockwise the heater (4 - lower part of the coff ee maker) Fig. A. 2. Fill the heater (4) with cold water without exceeding the opening of the safety valve level (Fig. B). 3. Insert the funnel fi lter (6) into the heater (4). Fig. C. 4. Fill the funnel fi lter (6) with ground coff ee for Moka, without pressing it down, taking care not to leave coff ee powder on the rim of the coff ee maker, Fig. D. 5. Assemble the cup support base (7) on the heater (4), by rotating the heater counterclockwise, and tighten well, without pressing too much and avoiding to force the column (1), Fig. E. 6. Put the coff ee maker on the heat source with the cups underneath the column (1) on the cup support base (7), Fig.F. In case of fl ame, make sure that it does not go beyond the rim of the coff ee maker. In case of induction/ electric/ceramic glass plate, do not use the highest heat. BIALETTI INSPECTION SAFETY VALVE (5) The Bialetti valve has been patented and designed to guarantee the use of the coff ee maker in complete safety. Using the coff ee maker with drinking water might entail the risk of formation of lime scale in the hole of the valve, causing its clogging. To avoid clogging arising from lime scale, just move the small piston coming out of the valve along its axis during the normal washing operations, Fig. F. It is advisable to carry out this inspection periodically to ensure its proper operation. The safety valve is a protective element and should intervene only in conditions of abnormal operation or use of the coff ee maker. CLEANING AND MAINTENANCE • Before carrying out cleaning and maintenance, wait for the appliance to cool down completely. • It is advisable to clean the coff ee maker in all its parts on a regular basis, including the dispensing column, which must be free from coff ee powder obstructions. • After each use, wash with warm water without detergents and/or abrasive materials (the product CANNOT be put in the dishwasher). • Store the product perfectly dry in all its parts and not closed to prevent any build-up of stains/oxidations. • Regularly perform the decalcifi cation procedure: 1. Fill the heater with water as per normal preparation. 2. Add two teaspoons of citric acid or vinegar. 3. Reassemble the product and, without adding any coff ee powder, dispense once. 4. Throw away the solution obtained. 5. Wash the coff ee maker under running water and make coff ee. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, avoiding a proper sealing. • Regularly check that the holes of the fi lter plate (2) are not obstructed, otherwise open them using a brush with delicate bristles or a needle. • Periodically check the internal components and, in case of wearing or damage, replace them only with original Bialetti spare parts suitable for the model used. • Replace the gasket (3), if worn. It is advisable to replace it at least once a • At the end of the life of the product, dispose it in a waste collection centre. • The adequate waste sorting and the correct disposal contribute to avoid negative impacts on the environment and public health and permit recycling of the materials which the product is made of. • For more detailed information regarding the available collection systems, contract the local refuse centre or the store where the product was purchased.
|
Respond using only information provided. Do not use any external knowledge or information.
EVIDENCE:
WARNINGS Read the instructions carefully as they contain important information about safety, use and maintenance of the product. IMPORTANT: READ THIS MANUAL THOROUGHLY AND KEEP IT WITH CARE FOR FUTURE REFERENCE. • These instructions are an integral part of the product and, throughout the entire life of the product, must be kept and be available. The documentation should be given to the subsequent owners of the product. • Attention: this coff ee maker requires a heat source for its operation and develops pressure inside. Failure to comply with the instructions may cause the risk of burn or the coff ee maker burst. • Before each use, make sure the coff ee maker is not damaged and is complete with all its parts. In case of doubts, contact the dealer or the manufacturer. • Remove the packaging materials of the coff ee maker and any warning inside it before use. • This appliance is not intended for use by persons (including children) with reduced physical, sensory or mental capabilities, or lack of experience and knowledge. • Keep out of reach of children. • Use the coff ee maker for the purpose that it was designed for. The product is intended for household use only. • Do not leave the appliance unattended during operation. • Do not touch the hot surface of the coff ee maker. The surfaces get hot, therefore use the handle (1) to move the coff ee maker. • Never use the coff ee maker without water in the heater. • Never use other liquids in the heater or the upper part, the coff ee maker is intended to be used with water only. • The coff ee maker is designed to be used only with water and ground coff ee for Moka for household use: do not use other products (e.g. barley, cocoa, coff ee extracts, tea, COFFEE FOR PERCOLATING FILTERS OR ESPRESSO MACHINES, etc.). • Make sure the steam jet is oriented far from the user, by ensuring the safety valve is not oriented towards the user. • Do not leave the coff ee maker on the heat source for too long to prevent any change in colour. • Make sure the coff ee maker is properly closed before use. • When using a gas heat source, the fl ame must not go beyond the rim of the heater. • In case of induction/electric/ceramic glass plate, never use the highest heat, but maintain a medium setting. In case of induction plate, never use the boost function. • Do not open or close the coff ee maker by forcing the column (1). • Never use the coff ee maker in the oven or in a microwave. • During use, close the cup support base (7) of the coff ee maker. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. • After use, allow the coff ee maker to cool down before opening it. • After use, place the coff ee maker on suitable surfaces, as its base reaches high temperatures. Do not store it in contact with fl ammable surfaces that might deteriorate with the heat. • Choose only original Bialetti spare parts suitable for the model used. • At the end of dispensing there might be some water in the heater. Such residue helps avoid possible changes in colour of the heater surface in case the coff ee maker is left on the heat source for a prolonged period of time after dispensing. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. INSTRUCTIONS FOR USE First use of the product • When using the coff ee maker for the fi rst time, wash it thoroughly, only with water, and make at least 3 cups of coff ee, discarding them (do not drink them). • For the use on induction, check the compatibility of the diameter of the coff ee maker heater with the technical features of the hob. • Check the coff ee maker is complete with all its components and is properly positioned, as shown in the fi gure. Check the coff ee maker is complete with safety valve, funnel fi lter, gasket and fi lter plate and that these parts are in the correct position (5-6-3-2). • Do not drink the fi rst 3 dispensing operations of coff ee as they are necessary for enhancing the aroma of coff ee at best. • Make sure the safety valve is not oriented towards the user. • Hand wash only without using detergents and abrasive sponges to preserve its features over the time. • Use ground coff ee for Moka, that is with a suitable grinding, and never use fi ne grinding coff ee. • Never press coff ee into the funnel. • Store each part of the coff ee maker completely dry and without closing it. • Replace the gasket, if worn. It is recommended to replace it at least once a year anyway. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, jeopardizing a proper sealing. MAKING COFFEE 1. Remove the cup support base (7 - upper part of the coff ee maker) and, without forcing the column (1), rotate clockwise the heater (4 - lower part of the coff ee maker) Fig. A. 2. Fill the heater (4) with cold water without exceeding the opening of the safety valve level (Fig. B). 3. Insert the funnel fi lter (6) into the heater (4). Fig. C. 4. Fill the funnel fi lter (6) with ground coff ee for Moka, without pressing it down, taking care not to leave coff ee powder on the rim of the coff ee maker, Fig. D. 5. Assemble the cup support base (7) on the heater (4), by rotating the heater counterclockwise, and tighten well, without pressing too much and avoiding to force the column (1), Fig. E. 6. Put the coff ee maker on the heat source with the cups underneath the column (1) on the cup support base (7), Fig.F. In case of fl ame, make sure that it does not go beyond the rim of the coff ee maker. In case of induction/ electric/ceramic glass plate, do not use the highest heat. BIALETTI INSPECTION SAFETY VALVE (5) The Bialetti valve has been patented and designed to guarantee the use of the coff ee maker in complete safety. Using the coff ee maker with drinking water might entail the risk of formation of lime scale in the hole of the valve, causing its clogging. To avoid clogging arising from lime scale, just move the small piston coming out of the valve along its axis during the normal washing operations, Fig. F. It is advisable to carry out this inspection periodically to ensure its proper operation. The safety valve is a protective element and should intervene only in conditions of abnormal operation or use of the coff ee maker. CLEANING AND MAINTENANCE • Before carrying out cleaning and maintenance, wait for the appliance to cool down completely. • It is advisable to clean the coff ee maker in all its parts on a regular basis, including the dispensing column, which must be free from coff ee powder obstructions. • After each use, wash with warm water without detergents and/or abrasive materials (the product CANNOT be put in the dishwasher). • Store the product perfectly dry in all its parts and not closed to prevent any build-up of stains/oxidations. • Regularly perform the decalcifi cation procedure: 1. Fill the heater with water as per normal preparation. 2. Add two teaspoons of citric acid or vinegar. 3. Reassemble the product and, without adding any coff ee powder, dispense once. 4. Throw away the solution obtained. 5. Wash the coff ee maker under running water and make coff ee. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, avoiding a proper sealing. • Regularly check that the holes of the fi lter plate (2) are not obstructed, otherwise open them using a brush with delicate bristles or a needle. • Periodically check the internal components and, in case of wearing or damage, replace them only with original Bialetti spare parts suitable for the model used. • Replace the gasket (3), if worn. It is advisable to replace it at least once a • At the end of the life of the product, dispose it in a waste collection centre. • The adequate waste sorting and the correct disposal contribute to avoid negative impacts on the environment and public health and permit recycling of the materials which the product is made of. • For more detailed information regarding the available collection systems, contract the local refuse centre or the store where the product was purchased.
USER:
Assume I just bought this product. How do I use it?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 13 | 11 | 1,478 | null | 808 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
|
I need a thesis statement, fit for a 2nd year undergrad paper, on the potential clinical effects of a training guided by the concept of 'Paideia' on one hand and standard technical training on the other, in no more than 300 words.
|
In the health area, a habitual behavior is observed among professionals of using knowledge about diseases and treatments (generating authority) over the passivity of those who need care – the patient (perpetuating dependence) – and this marks a strong characteristic of paternalism. For many professionals, it is difficult to assess an individual’s ability to decide on an indication based on clinical and laboratory evaluation. Often, there is still a very strong belief in professional knowledge as sovereign1.Involving patients in decision-making helps professionals ensure that the treatment provided reflects their preferences and values. Ethics, here understood as a reflection on moral and deontological norms and rules and the values that should guide how professionals should behave, is essential to the practice of health care, and respect for patient autonomy is present in the professions’ codes of ethics. Patients must have the exercise of their autonomy fully guaranteed. Thus, all information must be presented, allowing this autonomy to be exercised2-5.It is recommended that professionals make decisions considering clinical, epidemiological, psychosocial and ethical aspects, never forgetting that these complement each other. With this in mind, it is necessary to consider that competencies can be understood as the skills and knowledge that are acquired throughout training. When we talk about healthcare professionals, understanding the user’s role in decision-making is a competency that needs to be acquired by everyone. Thus, we must remember that the logic of training in the dierent specialties in some health courses, such as medicine, nursing and nutrition, including specialization in Nephrology, is focused on the idea of clinical skills, that is, education acts as a teaching guide for including the professionals into the work process, but often it does not work as Paideia (broad, holistic training with cultural identity) and perpetuates the status quo of technical, procedure-centered training5-7.The vision of skills has been changing daily, as the place of study has expanded. As authors have suggested, there is a need for training that understands the reality of the population, and not just the constant identification of diseases and pre-determined treatments. In this sense, providing the training of reflective professionals who are less attentive to the closed content of the disciplines, developing autonomy, focusing on learning to learn and the student’s protagonism, with the aim of creating care practices that go beyond the strict needs of a population that has a specific characteristic, and yes, the look at the extramural scenario that society presents6-7.Most schools that train health specialties rely on educational methods that support technological logic, focusing on imaging and equipment, dispensing with or makinglearning about interpersonal relationships a secondary aspect. The work of the dierent professionals who comprise the team must be orchestrated and aligned, to present a relationship with the user that directs the team’s form and action. The construction of knowledge occurs through collective lines of force, especially when we are talking about health care6,8. When thinking about strategies to improve professional training, we must look at the national curricular guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate courses in the health area. Since 2001, the articulation between the training of professionals and the field of health practice has been presented as necessary and essential. The resolutions show the need to promote graduates capable of working in the promotion, prevention, recovery and rehabilitation of health, through generalist, humanist, critical and reflective training to work with quality, competence and respecting the principles of ethics/bioethics, noting that health care goes beyond the technical act of care, requiring the resolution of individual and collective health problems. It is worth noting that the same is expected in the competency matrix for the training of nephrology specialists.
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[question] I need a thesis statement, fit for a 2nd year undergrad paper, on the potential clinical effects of a training guided by the concept of 'Paideia' on one hand and standard technical training on the other, in no more than 300 words. ===================== [text] In the health area, a habitual behavior is observed among professionals of using knowledge about diseases and treatments (generating authority) over the passivity of those who need care – the patient (perpetuating dependence) – and this marks a strong characteristic of paternalism. For many professionals, it is difficult to assess an individual’s ability to decide on an indication based on clinical and laboratory evaluation. Often, there is still a very strong belief in professional knowledge as sovereign1.Involving patients in decision-making helps professionals ensure that the treatment provided reflects their preferences and values. Ethics, here understood as a reflection on moral and deontological norms and rules and the values that should guide how professionals should behave, is essential to the practice of health care, and respect for patient autonomy is present in the professions’ codes of ethics. Patients must have the exercise of their autonomy fully guaranteed. Thus, all information must be presented, allowing this autonomy to be exercised2-5.It is recommended that professionals make decisions considering clinical, epidemiological, psychosocial and ethical aspects, never forgetting that these complement each other. With this in mind, it is necessary to consider that competencies can be understood as the skills and knowledge that are acquired throughout training. When we talk about healthcare professionals, understanding the user’s role in decision-making is a competency that needs to be acquired by everyone. Thus, we must remember that the logic of training in the dierent specialties in some health courses, such as medicine, nursing and nutrition, including specialization in Nephrology, is focused on the idea of clinical skills, that is, education acts as a teaching guide for including the professionals into the work process, but often it does not work as Paideia (broad, holistic training with cultural identity) and perpetuates the status quo of technical, procedure-centered training5-7.The vision of skills has been changing daily, as the place of study has expanded. As authors have suggested, there is a need for training that understands the reality of the population, and not just the constant identification of diseases and pre-determined treatments. In this sense, providing the training of reflective professionals who are less attentive to the closed content of the disciplines, developing autonomy, focusing on learning to learn and the student’s protagonism, with the aim of creating care practices that go beyond the strict needs of a population that has a specific characteristic, and yes, the look at the extramural scenario that society presents6-7.Most schools that train health specialties rely on educational methods that support technological logic, focusing on imaging and equipment, dispensing with or makinglearning about interpersonal relationships a secondary aspect. The work of the dierent professionals who comprise the team must be orchestrated and aligned, to present a relationship with the user that directs the team’s form and action. The construction of knowledge occurs through collective lines of force, especially when we are talking about health care6,8. When thinking about strategies to improve professional training, we must look at the national curricular guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate courses in the health area. Since 2001, the articulation between the training of professionals and the field of health practice has been presented as necessary and essential. The resolutions show the need to promote graduates capable of working in the promotion, prevention, recovery and rehabilitation of health, through generalist, humanist, critical and reflective training to work with quality, competence and respecting the principles of ethics/bioethics, noting that health care goes beyond the technical act of care, requiring the resolution of individual and collective health problems. It is worth noting that the same is expected in the competency matrix for the training of nephrology specialists. https://www.researchgate.net/publication/384023444_Nephrologist_training_a_bioethical_analysis ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
In the health area, a habitual behavior is observed among professionals of using knowledge about diseases and treatments (generating authority) over the passivity of those who need care – the patient (perpetuating dependence) – and this marks a strong characteristic of paternalism. For many professionals, it is difficult to assess an individual’s ability to decide on an indication based on clinical and laboratory evaluation. Often, there is still a very strong belief in professional knowledge as sovereign1.Involving patients in decision-making helps professionals ensure that the treatment provided reflects their preferences and values. Ethics, here understood as a reflection on moral and deontological norms and rules and the values that should guide how professionals should behave, is essential to the practice of health care, and respect for patient autonomy is present in the professions’ codes of ethics. Patients must have the exercise of their autonomy fully guaranteed. Thus, all information must be presented, allowing this autonomy to be exercised2-5.It is recommended that professionals make decisions considering clinical, epidemiological, psychosocial and ethical aspects, never forgetting that these complement each other. With this in mind, it is necessary to consider that competencies can be understood as the skills and knowledge that are acquired throughout training. When we talk about healthcare professionals, understanding the user’s role in decision-making is a competency that needs to be acquired by everyone. Thus, we must remember that the logic of training in the dierent specialties in some health courses, such as medicine, nursing and nutrition, including specialization in Nephrology, is focused on the idea of clinical skills, that is, education acts as a teaching guide for including the professionals into the work process, but often it does not work as Paideia (broad, holistic training with cultural identity) and perpetuates the status quo of technical, procedure-centered training5-7.The vision of skills has been changing daily, as the place of study has expanded. As authors have suggested, there is a need for training that understands the reality of the population, and not just the constant identification of diseases and pre-determined treatments. In this sense, providing the training of reflective professionals who are less attentive to the closed content of the disciplines, developing autonomy, focusing on learning to learn and the student’s protagonism, with the aim of creating care practices that go beyond the strict needs of a population that has a specific characteristic, and yes, the look at the extramural scenario that society presents6-7.Most schools that train health specialties rely on educational methods that support technological logic, focusing on imaging and equipment, dispensing with or makinglearning about interpersonal relationships a secondary aspect. The work of the dierent professionals who comprise the team must be orchestrated and aligned, to present a relationship with the user that directs the team’s form and action. The construction of knowledge occurs through collective lines of force, especially when we are talking about health care6,8. When thinking about strategies to improve professional training, we must look at the national curricular guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate courses in the health area. Since 2001, the articulation between the training of professionals and the field of health practice has been presented as necessary and essential. The resolutions show the need to promote graduates capable of working in the promotion, prevention, recovery and rehabilitation of health, through generalist, humanist, critical and reflective training to work with quality, competence and respecting the principles of ethics/bioethics, noting that health care goes beyond the technical act of care, requiring the resolution of individual and collective health problems. It is worth noting that the same is expected in the competency matrix for the training of nephrology specialists.
USER:
I need a thesis statement, fit for a 2nd year undergrad paper, on the potential clinical effects of a training guided by the concept of 'Paideia' on one hand and standard technical training on the other, in no more than 300 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 42 | 604 | null | 464 |
Use only the details found in the text above to inform your answer.
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Which composers are credited with creating and expanding the framework for aleatory composition in its early days?
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8 In section 4 we discussed various tendencies that began to emerge during and after the phase of punctual music. Around 1956 these became much clearer and enabled composers to draw certain conclusions. 1. The statistical approach to music came to the foreground. The primary consideration became the ordering of higher categories of form rather than the organisation of detail. This was already indicated by use of the term 'group' to refer to what is really the smallest unit, characterised by the detailed effect of pitch, duration, timbre, etc.; within the group, however, a certain freedom was possible without encroaching on the characteristic of the group. This freedom was also evident in an easier use of interval proportions than was ever conceivable in classical dodecaphony. It was no longer a question of 'this and this' or 'so and so many notes, but of a certain degree of density. Density, register, direction of movement, degree of periodicity and many other concepts emerged as aspects of music that could be ordered serially. Attention to elements of detail made way for a more global determination, and thus for the concept of form. 2. In this process the series became increasingly neutral, functioning more and more as a regulatory factor. Proportions became decisive: a 3rd from a pitch series is a 5/4 proportion that can be manifest in any other musical ele- ment. In so far as pitch series were still employed, they likewise had a neutral character and were naturally no longer bound to the twelve notes. The series in Gruppen still had twelve notes, and indeed a pronounced shape of its own, presumably to attain large proportional contrasts in the macrofield. The Klavierstücke I-IV however, dating from 1954, retained only the rudiments of the 12-note series. In the second and third pieces, respectively, they are as fol- lows: Nono's Il Canto sospeso (1956) was based on the all-interval series shown in Example 109. Something similiar occurred in Messiaen's Livre d'Orgue (see Example 16). 3. The outstanding scholar Györgi Ligeti, who has already been mentioned, introduced the concept of interval permeability. In section 4 we have already observed how the interval, and indeed other musical elements too, lost its own existence by being taken up in higher, statistically determinable quanti- ties.4 This desensitisation evoked new problems and new possibilities. The music became manifest in layers, no longer characterised by the detail but by a global 'material state' (rough, granular, smooth, etc.). Such layers could be combined, and exact synchronisation was obviously no longer relevant. Indeed, exactness acquired a certain margin: synchronism was not essential, but rather the spatial distribution of 'material states'. Something of the sort had already been achieved by Messiaen, among others, with his modality, in which a certain indifferentiation likewise arose in terms of sequence of notes and intervals. In serial music composers went further: different tempos were combinable, and the new concept of field magnitude emerged, heralding another important phase in new music that is usually described as aleatory composition. 9 This did not appear out of thin air. Directly after the rigorously punctual style of the Structures, Boulez reacted with his Marteau sans Maître, completed in 1954, in which the tempo in particular fluctuates through the many changes, directions such as 'tempo et nuances très instables', etc. The work breathes a freedom and suppleness that reminds one immediately of Debussy. The many short notes, separate or clustered, and the irrational values create a sort of written-out rubato (see Example 35). This differentiation, which was also manifest, though somewhat differently, in Stockhausen's work of the same period, moved the latter to express the following thoughts (freely cited): 'An inaccuracy factor arises in performance. The areas within which this factor is manifest are time fields, and their dimensions are field magnitudes. In the past too this margin existed in performance, but was coincidental. Now we wish to capture these inaccuracies functionally. A series of field magnitudes, rather than a traditional series of fixated durations, can now be determinant.' This meant the abandonment of our quantitative system of fixed-value notation and the creation of a way of indicating the boundaries within which indeterminacy may occur, something that could be done in many ways. In Example 67 Boulez used the sign to indicate the boundaries within which a number of short notes may be freely placed. Stockhausen developed a different method to indicate action duration, based on the principle that note duration is no longer counted, but determined during performance by means of a particular action prescribed by the composer. Thus, the time between two notes, for instance, may depend on that required by the player to move his hand, on the degree of complexity of a given touch or pedal movement, or on breathing considerations, etc. Once again, such physiolog- ical reactions had always existed; but Stockhausen wished to incorporate them functionally in his music. Although it sounds paradoxical, all this revealed a desire to control musical elements that cannot be accurately com- mitted to paper. It is clear, therefore, that it was not a question of the absolute values of these elements, but of their mutual relationships. The rapidity of these innovations was remarkable. While the correspon- dence between macro- and micro-areas discussed in the previous sections was still hardly formulated, new territory was being explored. And each discovery required years of elaboration! Perhaps it was this hurried course of events that caused problems in Stockhausen's first composition in this field. Let us take a closer look at the Klavierstück XI of 1957. Nineteen groups are written down on a large piece of paper, all of very dif- ferent length and without any suggestion of sequence; some are illustrated in Example 110. According to the composer each group is in itself the result of serial ordering, based on different series to organise field magnitude propor- tions. We must take his word for it, since we have arrived at a situation in which serial manipulation can no longer be reconstructed without the help of the composer. Some groups include the familiar notes in small print that are to be played as fast as possible'. Action duration is taken into account, for the composer says that 'difficult chords and large leaps with one hand obviously require more time than simple chords and smaller intervals'. Although the notes in normal print have the customary quantitive notation of duration, an unexpected element is to play a role. Stockhausen prescribes the following: the performer is to glance unintentionally at the page and play the first group that catches his eye, in the tempo, dynamics and touch of his choice. The lat- ter, however, are classified by the composer beforehand: there are six tempos, for instance, ranging from tempo I, very fast, to tempo 6, very slow. Subsequently, the player's eye is caught unintentionally (without any attempt to connect particular groups) by another group which he now plays in accor- dance with directions given at the end of the previous group. Each group can be connected to any of the other eighteen, and all nineteen groups can there- fore be performed in the prescribed degrees of tempo, dynamics and touch. The characteristics of all groups are therefore variable within the chosen boundaries. The field magnitude of a following group is determined by indi- cations at the end of the preceding one. A performance does not necessarily include all the groups. If a group is repeated, indications are given for small modifications in the second render- ing, usually in the form of somewhat elementary octave transpositions. If a group occurs for a third time, it also brings one of the possible realisations of the whole piece to an end. The work is an example of open form, without direction or termination. The groups are spatially juxtaposed and can be com- bined in countless ways. In the many commentaries on this composition two aspects have been neglected or confused. 1. The action duration - a decidedly positive element. Instead of ‘counting' with a margin of inaccuracy, a spontaneous reaction arises, a realisation of the time structure at the moment of the action itself. Such music can therefore no longer be approached from the score, since the time structure is now deter- mined by the perception time of the performer himself, which is inseparable from physical reactions and abilities. Such freedom is therefore ostensible. Nothing is added to an existing structure (unlike jazz or basso continuo tech- nique); on the contrary, the player remains entirely bound to the composer's directions, but he becomes involved right down to his physical reactions. Notice that this action duration takes place within the boundaries of each group. The mutual bond between the groups is quite a different matter; it is created by means of what one could call: 2. the spontaneous decision. The player is required to glance 'unintention- ally' and to link the very first group that catches his eye with the preceding one. The word 'chance' crops up here and is indeed to stay with us, whether relevant or not. But it is not a question of chance, for the performer may choose from no more than the 18 options determined by the composer. All possibilities are already enclosed in the concept. At best there is mention of an unconsidered decision at the last moment - freedom, indeed, but a free- dom without sense. The actual time experience of the action duration is absent, as is the considered decision of the composition process. It is a free- dom that is only possible thanks to another concept of form, that of the open form without causality. These new concepts of form have already been dis- cussed at several points, especially in relation to the theory of musical space. In this light Stockhausen's Klavierstück XI is hardly new, but merely a confir- mation of a concept of form already found in Debussy. Stockhausen's step was to transfer choice from the composer to the per- former; instead of a single notated version, many realisations of a piece become feasible. - Boulez was the first to recognise the real problem of the Klavierstück XI. In the same period, but independently of Stockhausen, he worked on his Third Piano Sonata; at the same time he was confronted by the work of Mallarmé, whose literary preoccupations ran remarkably parallel despite the great dis- parity in time. In Boulez, too, the player gains a more important role, but this does nothing the composer believes - to change the problem of form. He felt the necessity to develop a new form that adapts to the material available to the serial composer, which was constantly becoming more elastic. But form to Boulez was something more than the mosaics of Stockhausen's music, which were really nothing other than constantly changing combinations from millions of options. If the performer was free to choose, then his choice should preferably be made after some consideration, and with only a very lim- ited number of possibilities that were precisely determined by the composer. An example is the overall structure of the Sonata (comprising five move- ments in the first concept): Antiphonie, Trope, Constellation, Strophe, Séquence. The sequence of the movements is free, providing that Constellation is always in the middle. The internal structure reflects the same approach. One of the movements, Trope, has four components: two so-called structures complexes (Parenthèse, Commentaire) and two structures simples (Glose, Texte). In the 'complex structures' the performer is again free to include or omit certain additional variants (given between brackets). The sequence of these components is indicated in an ingenious manner. The unnumbered pages of the score are in a ring binder, and the player may begin where he wishes. The sequence is therefore directed - we usually read from front to back - but not predetermined (Boulez speaks of a forme circu- laire). There are normally four options, therefore, depending on the starting point: - P, C, C, G, T G, T, P G, T, P C T, P, C, G But since the Commentaire section is included twice, four other possibilities become available, depending on where this section is placed (it may only be performed once); this can be represented as in Figure 7. Altogether eight dif- ferent sequences are therefore available; compared to the millions in Stockhausen, this illustrates just how much more control the composer has retained over the final outcome. The Trope from Boulez's Third Piano Sonata provided only a first and simple answer to the new problems of form. Although the composer already estab- lished new structural concepts, the territory as such was as yet hardly explored. This is particularly evident if we bear in mind that the free sequence of sections, which caused the most sensation in the beginning, was merely one aspect of the complex concept of form that awaited exploitation. However the case may be, through these preoccupations, form acquired unprecedented autonomy, despite the astonishing authority granted (for the time being) to the performer. This is already observed in the work of Mallarmé, who concentrated far more on the structure of language than on its significance, or, in other words, attempted to convert this significance into a symbolism of absolute value. Form had a life of its own, bringing the artist to an attitude of anonymity, since the intrusion of purely personal incidents was undesirable. Those with some knowledge of Asian culture will hardly be surprised by this. But in Europe relationships are different, and particularly for those less gifted than Boulez it is fitting to recall the words of Paul Valéry, a confidant of Mallarmé. Concerning the latter's ambitions he spoke later (in his Lettre sur Mallarme) of 'diviniser la chose écrite' (divining that which is written). But, he went on, 'ce n'est point l'œuvre faite et ses apparences ou ses effets dans le monde qui peuvent nous accomplir et nous édifier, mais seule- ment la manière dont nous l'avons faite (it is not the finished work and its appearances, or its effects on the world, which can fulfill and edify us, but only the manner in which we have accomplished it). IO The concept of aleatory music has now broadened considerably, and we must certainly mention one other composer under this heading. We have already examined two aspects: action duration and the sponta- neous decision in Stockhausen, and intervention possibilities in Boulez. In the latter the performer is like a driver who may choose from a limited num- ber of roads, while the road map itself remains the domain of the town plan- ner. Boulez described Stockhausen's solution as chance, while Stockhausen used the term gelenkter Zufall (guided chance); but as we have seen, in reali- ty the element of chance was less present than one might imagine. All this only made the problem of form most acute, and the composer who was to draw particularly radical conclusions was the American John Cage. Cage came to Europe in 1958 - I remember a momentous concert at the World Exhibition in Brussels - and was quick to cause the necessary stir. From his point of view our controversy between tonality and atonality was long out- dated. He believed that modern serialists kept far too much to traditional paths, exposing themselves to a constant risk of academicism. A number of similarities, however, can also be found. Like Boulez, Cage's music reveals a pursuit of objectivity, or rather anonymity, which helps the sound to 'come to itself'. But his conclusions were much more radical. Instead of trying to bind the notes, his school attempted to soak off their adhesive, formed as it was by centuries of convention. If one hangs on to the notes, if one has 'musical' ideas, one cannot allow the notes to be themselves. And 'being themselves' means that there is no superimposed expression. (Many modern composers would go along with him up to this point, and the much older Varèse, with his 'liberation of the sound', was even a precursor.) And it also means that there is no man-made organisation. Thus, Cage reached a conclusion diametrically opposed to our early serialists: not com- plete determination, but rather complete indetermination was essential. (One of the most shocking experiences of recent times is to discover that both points of departure lead to the same degree of indetermination.) In order to achieve this indetermination, Cage used to make particular use of chance actions such as the tossing of coins, etc. Other means may also be employed, such as the oracle of the staves from the ancient Chinese book I-Ching (which illustrates the influence of Zen Buddhism on this composer), or mathemati- cal methods. More recently, however, the accent has shifted towards the unforeseeable- ness of the performance itself, involving the actual performers. It is remark- able how completely different paths form striking parallels with modern European composers! Fifty years earlier Charles Ives, following quite a differ- ent line of thought, created the same sort of music as that of the young Schönberg and Stravinsky. Despite the shift towards live performance, a score was naturally still required as an instruction for the players. But the score must not be viewed as a ready-made, notated form. And this is where Cage differs: the composition is not an autonomous object, but a performance process. Obviously, this process has its boundaries - determined by the action of the players and by a number of characteristics - but essentially the music has no precedence above either note or noise. While it does have its own exis- tence, it remains 'transparent' in relation to its surroundings. Its boundaries become diffuse, and counting is not required, for we exist in time'. Stopwatches rather than bars serve to indicate when an occurrence of sound must take place within this time. Christian Wolff, a composer from the Cage group, replaced Stockhausen's eye ('unintentional glancing') with the ear: cer- tain occurrences of sound, caused by the one player, evoke reactions from the other (Duo for Pianists II). The outcome is determined by the performers themselves; finally, musical form may be conceived as 'the length of the pro- gramme'.7 Cage is among those Westerners who have listened to the Japanese bow- 8 man in chapter 6. Just how far his interpretation is correct, we will leave to the experts. Is this still music? Surely we see an influence on contemporary music that cannot be underestimated. Can everybody do the same? But not everybody does, is Cage's reply. Strong differences of opinion emerge. It is impossible to imagine the fascinating whirlpool of new developments with- out Cage. Whether the music comes from inside or outside, we cannot escape it. 'One day when the windows were open, Christian Wolff played one of his pieces at the piano. Sounds of traffic, boat horns, were heard not only during the silences in the music but, being louder, were more easily heard than the piano sounds themselves. Afterwards, someone asked Christian Wolff to play the piece again with the windows closed. Christian Wolff said he'd be glad to, but that it wasn't really necessary, since the sounds of the environment were in no sense an interruption of those of the music.' II The above discussion helps us to clarify the concept of aleatory music. It is a generic term for all aspects of music that are not predetermined. The rela- tionship between determined and undetermined elements plays a role in all types of music. The undetermined element brings unforeseeableness with it, and can occur both in performance and during the process of composition. Unforeseeableness can be manifest in differing degrees. In the perform- ance of a classical composition, for example, the degree to which the fixated notation can be deviated from is limited. Performance of a piece by John Cage, on the other hand, can involve a high degree of unforeseeableness. But even here general patterns of expectation can be formulated. Finally, with regard to developments in the music of the period 1950-60, the following aspects are of importance: more 1. In Cage's work the element of chance to use this dubious word once - was a means to obtain indetermination and to escape from the human grasp of the music. Young European composers, on the other hand, were con- cerned with gaining even stricter control of the musical material: even this indeterminable area of free choice was consciously incorporated in the of composition. process 2. Bearing in mind changing concepts of musical form, we can say that part of what once belonged to the individual and 'unique' work of art is now ascribed to the material employed by the performers. There is a certain incli- nation to make matters absolute, which corresponds logically to the excessive attention given to musical material that we have observed from 1950 onwards. 3. Expansionism, moreover, is not foreign to serial technique, in the sense that there is an inclination to exploit all the possibilities of the chosen mate- rial. The limited means of dodecaphony of the past have been extended to become an all-embracing permutation procedure; it soon became apparent, however, that this again was not sufficient to harness the wealth of resources that had been rallied. A written serial score realises only a few of the count- less possibilities, and the free choice of the performer can at least compensate this to a certain extent. The element of chance becomes a wider margin in the realisation of the (unforeseeable) permutation process. Far from coincidental is the attendant departure from the unique, once-and-for-all determined work of art. A remarkable dichotomy seems to arise between the realised con- dition of a single work of art and the 'possibly realisable' that is potentially present in the same. Here creative expansionism collides with ultimate boundaries. 4. The element of chance can serve to fill another gap. With all due respect for their sometimes brilliant ideas, one can nonetheless consider that both Stockhausen and Boulez have maintained an only too simple notion of the role of what they call 'surprise' in the musical process. The former wrote: "The degree of information is therefore at its highest when at any point in a musi- cal discourse the moment of surprise is at its strongest: the music constantly has "something to say". (Just before this he specifies: 'Surprise only occurs when the unexpected happens.')" Boulez shares this opinion: "... for any music that is a masterpiece is a music that allows the capacity to surprise at any moment. This is not the place to contradict these ideas, but it is clear that from this point of view too, the involvement of the spontaneous decision of the per- former is most welcome: the 'surprise' within the boundaries of a work may increase, and the same goes for each subsequent performance. 5. Increasing differentiation posed considerable problems with regard to traditional notation, which was not at all equal to its task. By involving the performer, this difficulty was eased on the one hand, while on the other new symbols had to be introduced to indicate players' actions. It was inevitable that this issue also had to be tackled once more, as is described in section 14. 12 In the reaction against abstractions, serial music lost more and more influence after 1960. Boulez has remained a bastion of serial academicism, but Stockhausen has changed enormously. He is no longer the great renewer, but continues to react with great flexibility to any external stimulus that he encounters. He is long past the stage of solving problems of form and tech- nique. From Carré (1960) and Originale (1961) onwards his work comprises. ever more heterogeneous elements including happenings, pop, quotations, indeterminate sound production (contact microphones), etc. The use of contact microphones has now become very widespread, and this opens up a new direction in the application of electronic resources. In days past, electronic music was accurately recorded on tape in a studio. Many considered this an advantage: the composer exercised maximum control, while the inconstancies of live performance were eliminated. But this strict view could not be maintained, and in a next step (discussed in section 9) aleatory techniques were introduced, at first very cautiously among Europeans but after 1960 much more freely. Improvisation groups even appeared on stage working with electronic apparatus. The principle is simple: microphones attached to 'instruments' (that may or may not be recognisable as such) pick up vibrations that are normally neither audible nor usable and feed them to loudspeakers via amplifiers and possibly modulators. A new and hitherto unknown world of sound is brought to life. Unexpected surprises may occur too, and with them an immediate response from the performer. This was a typical feature of the post-1960 period. exper- Once again it was Cage who led the way with such experiments. More important, however, was his awareness of the situation. For in his first iments with chance phenomena he discovered that he was still attempting to drag 'successful' results out of chance actions. Realising later on that this atti- tude was equivocal, he came to accept the induced results of chance. The result was no longer important, but rather the attitude of open-mindedness. Thus, he came to distinguish between chance actions and indetermination. In the first case the composer employs chance as a means, but to a limited degree such that he remains within a self-determined global circle. Indetermination, on the contrary, exceeds this circle: the result is in every respect indefinite; such music crops up out of time, undefined and inciden- tal, only to disappear once more without a trace. All things are interrelated,' Cage said, and taken up in the stream of time. Any (human) pursuit of a stat- ed "aim" is a simplification, and a departure from reality.' The lessons of Cage were developed further by an American ‘second generation' around 1960. And once again the aesthetic consequences of the concept of indetermination were applied more radically than in Europe. In the work of La Monte Young, Terry Riley, Robert Ashley and the Fluxus Movement, almost all existing values and concepts relating to music were turned well and truly upside down. La Monte Young (1935) worked with long chains of chords that developed systematically. His material is economical, and naturally comprises all that is 'sound', including that produced by nature, machines, and electronic resources. Performances may last a week or more and incorporate other ele- ments such as light, movement and theatre. His contemporary Terry Riley followed the same course. His music consists of long chains of repeated motifs, usually in elementary diatonic note patterns. Tape loops and feedback systems provide the characteristic tone colours; electronic and instrumental resources merge. These and other Americans shared a broad interest in wide- ly different idioms including jazz, pop and non-Western music. Chance action - indetermination: many composers throughout the world now work within these borders. Only few are conscious of the background so brilliantly evoked by Cage in his writings. What is clear, however, is that serial concepts are disappearing; there is a growing reaction to their abstrac- tions and a tendency towards greater directness in music making. This is also expressed in the instrumental works of Berio, Ligeti, Kagel and others: music that is tailor-made for certain specialists, musicians who are required to make a creative contribution of their own rather than only faithfully reproduce a more or less authoritarian score. Such music renounces serial, abstractly deter- mined sound differentiation in favour of a more direct form of expression. Not only the actual notes, but sighs, scratches, shouts and moans become part of music making. The instrument literally becomes an extension of the human body. Similar tendencies are found in music theatre. This rather vague term embodies so much variety that a comprehensive definition can hardly be given. In general, it can be viewed as a reaction to traditional theatrical and operatic forms, which have caused the nineteenth century to live on, leaving current issues to the realm of film. The 'raree show' idea has also been aban- doned, since divisions between audience and stage, between different partic- ipating disciplines, required abolition. Various directions emerged, from the political engagement of Nono (Intolleranza, 1960) to the more light-hearted or autonomous approach of Kagel (Sur Scène, 1960) and Ligeti (Aventures, 1962). Nono connected with traditional opera, while Ligeti created a 'com- position with scenic, verbal and musical means'. Unlike the traditional Gesamtkunstwerk there is a tendency to grant the incorporated elements a life of their own, independent of one another and only joined by a common peri- od of time. Once again, vocal and instrumental techniques are extended to such a degree that the two flow together. All such innovations amount to repeated attempts to break through exist- ing boundaries! From the beginning of the twentieth century, the failure of instrument making to keep pace with musical developments made itself increasingly felt. Factories were usually highly industrialised, geared to the mass production of traditional instruments and leaving no room for altruis- tic research in an artistic sense. Today's composer must still make do with instruments developed hundreds of years ago: thus the continual expansion of playing techniques towards the boundaries of human endeavour; thus the contact microphones; and thus the ongoing specialisation of the few players devoted exclusively to new music.
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8 In section 4 we discussed various tendencies that began to emerge during and after the phase of punctual music. Around 1956 these became much clearer and enabled composers to draw certain conclusions. 1. The statistical approach to music came to the foreground. The primary consideration became the ordering of higher categories of form rather than the organisation of detail. This was already indicated by use of the term 'group' to refer to what is really the smallest unit, characterised by the detailed effect of pitch, duration, timbre, etc.; within the group, however, a certain freedom was possible without encroaching on the characteristic of the group. This freedom was also evident in an easier use of interval proportions than was ever conceivable in classical dodecaphony. It was no longer a question of 'this and this' or 'so and so many notes, but of a certain degree of density. Density, register, direction of movement, degree of periodicity and many other concepts emerged as aspects of music that could be ordered serially. Attention to elements of detail made way for a more global determination, and thus for the concept of form. 2. In this process the series became increasingly neutral, functioning more and more as a regulatory factor. Proportions became decisive: a 3rd from a pitch series is a 5/4 proportion that can be manifest in any other musical ele- ment. In so far as pitch series were still employed, they likewise had a neutral character and were naturally no longer bound to the twelve notes. The series in Gruppen still had twelve notes, and indeed a pronounced shape of its own, presumably to attain large proportional contrasts in the macrofield. The Klavierstücke I-IV however, dating from 1954, retained only the rudiments of the 12-note series. In the second and third pieces, respectively, they are as fol- lows: Nono's Il Canto sospeso (1956) was based on the all-interval series shown in Example 109. Something similiar occurred in Messiaen's Livre d'Orgue (see Example 16). 3. The outstanding scholar Györgi Ligeti, who has already been mentioned, introduced the concept of interval permeability. In section 4 we have already observed how the interval, and indeed other musical elements too, lost its own existence by being taken up in higher, statistically determinable quanti- ties.4 This desensitisation evoked new problems and new possibilities. The music became manifest in layers, no longer characterised by the detail but by a global 'material state' (rough, granular, smooth, etc.). Such layers could be combined, and exact synchronisation was obviously no longer relevant. Indeed, exactness acquired a certain margin: synchronism was not essential, but rather the spatial distribution of 'material states'. Something of the sort had already been achieved by Messiaen, among others, with his modality, in which a certain indifferentiation likewise arose in terms of sequence of notes and intervals. In serial music composers went further: different tempos were combinable, and the new concept of field magnitude emerged, heralding another important phase in new music that is usually described as aleatory composition. 9 This did not appear out of thin air. Directly after the rigorously punctual style of the Structures, Boulez reacted with his Marteau sans Maître, completed in 1954, in which the tempo in particular fluctuates through the many changes, directions such as 'tempo et nuances très instables', etc. The work breathes a freedom and suppleness that reminds one immediately of Debussy. The many short notes, separate or clustered, and the irrational values create a sort of written-out rubato (see Example 35). This differentiation, which was also manifest, though somewhat differently, in Stockhausen's work of the same period, moved the latter to express the following thoughts (freely cited): 'An inaccuracy factor arises in performance. The areas within which this factor is manifest are time fields, and their dimensions are field magnitudes. In the past too this margin existed in performance, but was coincidental. Now we wish to capture these inaccuracies functionally. A series of field magnitudes, rather than a traditional series of fixated durations, can now be determinant.' This meant the abandonment of our quantitative system of fixed-value notation and the creation of a way of indicating the boundaries within which indeterminacy may occur, something that could be done in many ways. In Example 67 Boulez used the sign to indicate the boundaries within which a number of short notes may be freely placed. Stockhausen developed a different method to indicate action duration, based on the principle that note duration is no longer counted, but determined during performance by means of a particular action prescribed by the composer. Thus, the time between two notes, for instance, may depend on that required by the player to move his hand, on the degree of complexity of a given touch or pedal movement, or on breathing considerations, etc. Once again, such physiolog- ical reactions had always existed; but Stockhausen wished to incorporate them functionally in his music. Although it sounds paradoxical, all this revealed a desire to control musical elements that cannot be accurately com- mitted to paper. It is clear, therefore, that it was not a question of the absolute values of these elements, but of their mutual relationships. The rapidity of these innovations was remarkable. While the correspon- dence between macro- and micro-areas discussed in the previous sections was still hardly formulated, new territory was being explored. And each discovery required years of elaboration! Perhaps it was this hurried course of events that caused problems in Stockhausen's first composition in this field. Let us take a closer look at the Klavierstück XI of 1957. Nineteen groups are written down on a large piece of paper, all of very dif- ferent length and without any suggestion of sequence; some are illustrated in Example 110. According to the composer each group is in itself the result of serial ordering, based on different series to organise field magnitude propor- tions. We must take his word for it, since we have arrived at a situation in which serial manipulation can no longer be reconstructed without the help of the composer. Some groups include the familiar notes in small print that are to be played as fast as possible'. Action duration is taken into account, for the composer says that 'difficult chords and large leaps with one hand obviously require more time than simple chords and smaller intervals'. Although the notes in normal print have the customary quantitive notation of duration, an unexpected element is to play a role. Stockhausen prescribes the following: the performer is to glance unintentionally at the page and play the first group that catches his eye, in the tempo, dynamics and touch of his choice. The lat- ter, however, are classified by the composer beforehand: there are six tempos, for instance, ranging from tempo I, very fast, to tempo 6, very slow. Subsequently, the player's eye is caught unintentionally (without any attempt to connect particular groups) by another group which he now plays in accor- dance with directions given at the end of the previous group. Each group can be connected to any of the other eighteen, and all nineteen groups can there- fore be performed in the prescribed degrees of tempo, dynamics and touch. The characteristics of all groups are therefore variable within the chosen boundaries. The field magnitude of a following group is determined by indi- cations at the end of the preceding one. A performance does not necessarily include all the groups. If a group is repeated, indications are given for small modifications in the second render- ing, usually in the form of somewhat elementary octave transpositions. If a group occurs for a third time, it also brings one of the possible realisations of the whole piece to an end. The work is an example of open form, without direction or termination. The groups are spatially juxtaposed and can be com- bined in countless ways. In the many commentaries on this composition two aspects have been neglected or confused. 1. The action duration - a decidedly positive element. Instead of ‘counting' with a margin of inaccuracy, a spontaneous reaction arises, a realisation of the time structure at the moment of the action itself. Such music can therefore no longer be approached from the score, since the time structure is now deter- mined by the perception time of the performer himself, which is inseparable from physical reactions and abilities. Such freedom is therefore ostensible. Nothing is added to an existing structure (unlike jazz or basso continuo tech- nique); on the contrary, the player remains entirely bound to the composer's directions, but he becomes involved right down to his physical reactions. Notice that this action duration takes place within the boundaries of each group. The mutual bond between the groups is quite a different matter; it is created by means of what one could call: 2. the spontaneous decision. The player is required to glance 'unintention- ally' and to link the very first group that catches his eye with the preceding one. The word 'chance' crops up here and is indeed to stay with us, whether relevant or not. But it is not a question of chance, for the performer may choose from no more than the 18 options determined by the composer. All possibilities are already enclosed in the concept. At best there is mention of an unconsidered decision at the last moment - freedom, indeed, but a free- dom without sense. The actual time experience of the action duration is absent, as is the considered decision of the composition process. It is a free- dom that is only possible thanks to another concept of form, that of the open form without causality. These new concepts of form have already been dis- cussed at several points, especially in relation to the theory of musical space. In this light Stockhausen's Klavierstück XI is hardly new, but merely a confir- mation of a concept of form already found in Debussy. Stockhausen's step was to transfer choice from the composer to the per- former; instead of a single notated version, many realisations of a piece become feasible. - Boulez was the first to recognise the real problem of the Klavierstück XI. In the same period, but independently of Stockhausen, he worked on his Third Piano Sonata; at the same time he was confronted by the work of Mallarmé, whose literary preoccupations ran remarkably parallel despite the great dis- parity in time. In Boulez, too, the player gains a more important role, but this does nothing the composer believes - to change the problem of form. He felt the necessity to develop a new form that adapts to the material available to the serial composer, which was constantly becoming more elastic. But form to Boulez was something more than the mosaics of Stockhausen's music, which were really nothing other than constantly changing combinations from millions of options. If the performer was free to choose, then his choice should preferably be made after some consideration, and with only a very lim- ited number of possibilities that were precisely determined by the composer. An example is the overall structure of the Sonata (comprising five move- ments in the first concept): Antiphonie, Trope, Constellation, Strophe, Séquence. The sequence of the movements is free, providing that Constellation is always in the middle. The internal structure reflects the same approach. One of the movements, Trope, has four components: two so-called structures complexes (Parenthèse, Commentaire) and two structures simples (Glose, Texte). In the 'complex structures' the performer is again free to include or omit certain additional variants (given between brackets). The sequence of these components is indicated in an ingenious manner. The unnumbered pages of the score are in a ring binder, and the player may begin where he wishes. The sequence is therefore directed - we usually read from front to back - but not predetermined (Boulez speaks of a forme circu- laire). There are normally four options, therefore, depending on the starting point: - P, C, C, G, T G, T, P G, T, P C T, P, C, G But since the Commentaire section is included twice, four other possibilities become available, depending on where this section is placed (it may only be performed once); this can be represented as in Figure 7. Altogether eight dif- ferent sequences are therefore available; compared to the millions in Stockhausen, this illustrates just how much more control the composer has retained over the final outcome. The Trope from Boulez's Third Piano Sonata provided only a first and simple answer to the new problems of form. Although the composer already estab- lished new structural concepts, the territory as such was as yet hardly explored. This is particularly evident if we bear in mind that the free sequence of sections, which caused the most sensation in the beginning, was merely one aspect of the complex concept of form that awaited exploitation. However the case may be, through these preoccupations, form acquired unprecedented autonomy, despite the astonishing authority granted (for the time being) to the performer. This is already observed in the work of Mallarmé, who concentrated far more on the structure of language than on its significance, or, in other words, attempted to convert this significance into a symbolism of absolute value. Form had a life of its own, bringing the artist to an attitude of anonymity, since the intrusion of purely personal incidents was undesirable. Those with some knowledge of Asian culture will hardly be surprised by this. But in Europe relationships are different, and particularly for those less gifted than Boulez it is fitting to recall the words of Paul Valéry, a confidant of Mallarmé. Concerning the latter's ambitions he spoke later (in his Lettre sur Mallarme) of 'diviniser la chose écrite' (divining that which is written). But, he went on, 'ce n'est point l'œuvre faite et ses apparences ou ses effets dans le monde qui peuvent nous accomplir et nous édifier, mais seule- ment la manière dont nous l'avons faite (it is not the finished work and its appearances, or its effects on the world, which can fulfill and edify us, but only the manner in which we have accomplished it). IO The concept of aleatory music has now broadened considerably, and we must certainly mention one other composer under this heading. We have already examined two aspects: action duration and the sponta- neous decision in Stockhausen, and intervention possibilities in Boulez. In the latter the performer is like a driver who may choose from a limited num- ber of roads, while the road map itself remains the domain of the town plan- ner. Boulez described Stockhausen's solution as chance, while Stockhausen used the term gelenkter Zufall (guided chance); but as we have seen, in reali- ty the element of chance was less present than one might imagine. All this only made the problem of form most acute, and the composer who was to draw particularly radical conclusions was the American John Cage. Cage came to Europe in 1958 - I remember a momentous concert at the World Exhibition in Brussels - and was quick to cause the necessary stir. From his point of view our controversy between tonality and atonality was long out- dated. He believed that modern serialists kept far too much to traditional paths, exposing themselves to a constant risk of academicism. A number of similarities, however, can also be found. Like Boulez, Cage's music reveals a pursuit of objectivity, or rather anonymity, which helps the sound to 'come to itself'. But his conclusions were much more radical. Instead of trying to bind the notes, his school attempted to soak off their adhesive, formed as it was by centuries of convention. If one hangs on to the notes, if one has 'musical' ideas, one cannot allow the notes to be themselves. And 'being themselves' means that there is no superimposed expression. (Many modern composers would go along with him up to this point, and the much older Varèse, with his 'liberation of the sound', was even a precursor.) And it also means that there is no man-made organisation. Thus, Cage reached a conclusion diametrically opposed to our early serialists: not com- plete determination, but rather complete indetermination was essential. (One of the most shocking experiences of recent times is to discover that both points of departure lead to the same degree of indetermination.) In order to achieve this indetermination, Cage used to make particular use of chance actions such as the tossing of coins, etc. Other means may also be employed, such as the oracle of the staves from the ancient Chinese book I-Ching (which illustrates the influence of Zen Buddhism on this composer), or mathemati- cal methods. More recently, however, the accent has shifted towards the unforeseeable- ness of the performance itself, involving the actual performers. It is remark- able how completely different paths form striking parallels with modern European composers! Fifty years earlier Charles Ives, following quite a differ- ent line of thought, created the same sort of music as that of the young Schönberg and Stravinsky. Despite the shift towards live performance, a score was naturally still required as an instruction for the players. But the score must not be viewed as a ready-made, notated form. And this is where Cage differs: the composition is not an autonomous object, but a performance process. Obviously, this process has its boundaries - determined by the action of the players and by a number of characteristics - but essentially the music has no precedence above either note or noise. While it does have its own exis- tence, it remains 'transparent' in relation to its surroundings. Its boundaries become diffuse, and counting is not required, for we exist in time'. Stopwatches rather than bars serve to indicate when an occurrence of sound must take place within this time. Christian Wolff, a composer from the Cage group, replaced Stockhausen's eye ('unintentional glancing') with the ear: cer- tain occurrences of sound, caused by the one player, evoke reactions from the other (Duo for Pianists II). The outcome is determined by the performers themselves; finally, musical form may be conceived as 'the length of the pro- gramme'.7 Cage is among those Westerners who have listened to the Japanese bow- 8 man in chapter 6. Just how far his interpretation is correct, we will leave to the experts. Is this still music? Surely we see an influence on contemporary music that cannot be underestimated. Can everybody do the same? But not everybody does, is Cage's reply. Strong differences of opinion emerge. It is impossible to imagine the fascinating whirlpool of new developments with- out Cage. Whether the music comes from inside or outside, we cannot escape it. 'One day when the windows were open, Christian Wolff played one of his pieces at the piano. Sounds of traffic, boat horns, were heard not only during the silences in the music but, being louder, were more easily heard than the piano sounds themselves. Afterwards, someone asked Christian Wolff to play the piece again with the windows closed. Christian Wolff said he'd be glad to, but that it wasn't really necessary, since the sounds of the environment were in no sense an interruption of those of the music.' II The above discussion helps us to clarify the concept of aleatory music. It is a generic term for all aspects of music that are not predetermined. The rela- tionship between determined and undetermined elements plays a role in all types of music. The undetermined element brings unforeseeableness with it, and can occur both in performance and during the process of composition. Unforeseeableness can be manifest in differing degrees. In the perform- ance of a classical composition, for example, the degree to which the fixated notation can be deviated from is limited. Performance of a piece by John Cage, on the other hand, can involve a high degree of unforeseeableness. But even here general patterns of expectation can be formulated. Finally, with regard to developments in the music of the period 1950-60, the following aspects are of importance: more 1. In Cage's work the element of chance to use this dubious word once - was a means to obtain indetermination and to escape from the human grasp of the music. Young European composers, on the other hand, were con- cerned with gaining even stricter control of the musical material: even this indeterminable area of free choice was consciously incorporated in the of composition. process 2. Bearing in mind changing concepts of musical form, we can say that part of what once belonged to the individual and 'unique' work of art is now ascribed to the material employed by the performers. There is a certain incli- nation to make matters absolute, which corresponds logically to the excessive attention given to musical material that we have observed from 1950 onwards. 3. Expansionism, moreover, is not foreign to serial technique, in the sense that there is an inclination to exploit all the possibilities of the chosen mate- rial. The limited means of dodecaphony of the past have been extended to become an all-embracing permutation procedure; it soon became apparent, however, that this again was not sufficient to harness the wealth of resources that had been rallied. A written serial score realises only a few of the count- less possibilities, and the free choice of the performer can at least compensate this to a certain extent. The element of chance becomes a wider margin in the realisation of the (unforeseeable) permutation process. Far from coincidental is the attendant departure from the unique, once-and-for-all determined work of art. A remarkable dichotomy seems to arise between the realised con- dition of a single work of art and the 'possibly realisable' that is potentially present in the same. Here creative expansionism collides with ultimate boundaries. 4. The element of chance can serve to fill another gap. With all due respect for their sometimes brilliant ideas, one can nonetheless consider that both Stockhausen and Boulez have maintained an only too simple notion of the role of what they call 'surprise' in the musical process. The former wrote: "The degree of information is therefore at its highest when at any point in a musi- cal discourse the moment of surprise is at its strongest: the music constantly has "something to say". (Just before this he specifies: 'Surprise only occurs when the unexpected happens.')" Boulez shares this opinion: "... for any music that is a masterpiece is a music that allows the capacity to surprise at any moment. This is not the place to contradict these ideas, but it is clear that from this point of view too, the involvement of the spontaneous decision of the per- former is most welcome: the 'surprise' within the boundaries of a work may increase, and the same goes for each subsequent performance. 5. Increasing differentiation posed considerable problems with regard to traditional notation, which was not at all equal to its task. By involving the performer, this difficulty was eased on the one hand, while on the other new symbols had to be introduced to indicate players' actions. It was inevitable that this issue also had to be tackled once more, as is described in section 14. 12 In the reaction against abstractions, serial music lost more and more influence after 1960. Boulez has remained a bastion of serial academicism, but Stockhausen has changed enormously. He is no longer the great renewer, but continues to react with great flexibility to any external stimulus that he encounters. He is long past the stage of solving problems of form and tech- nique. From Carré (1960) and Originale (1961) onwards his work comprises. ever more heterogeneous elements including happenings, pop, quotations, indeterminate sound production (contact microphones), etc. The use of contact microphones has now become very widespread, and this opens up a new direction in the application of electronic resources. In days past, electronic music was accurately recorded on tape in a studio. Many considered this an advantage: the composer exercised maximum control, while the inconstancies of live performance were eliminated. But this strict view could not be maintained, and in a next step (discussed in section 9) aleatory techniques were introduced, at first very cautiously among Europeans but after 1960 much more freely. Improvisation groups even appeared on stage working with electronic apparatus. The principle is simple: microphones attached to 'instruments' (that may or may not be recognisable as such) pick up vibrations that are normally neither audible nor usable and feed them to loudspeakers via amplifiers and possibly modulators. A new and hitherto unknown world of sound is brought to life. Unexpected surprises may occur too, and with them an immediate response from the performer. This was a typical feature of the post-1960 period. exper- Once again it was Cage who led the way with such experiments. More important, however, was his awareness of the situation. For in his first iments with chance phenomena he discovered that he was still attempting to drag 'successful' results out of chance actions. Realising later on that this atti- tude was equivocal, he came to accept the induced results of chance. The result was no longer important, but rather the attitude of open-mindedness. Thus, he came to distinguish between chance actions and indetermination. In the first case the composer employs chance as a means, but to a limited degree such that he remains within a self-determined global circle. Indetermination, on the contrary, exceeds this circle: the result is in every respect indefinite; such music crops up out of time, undefined and inciden- tal, only to disappear once more without a trace. All things are interrelated,' Cage said, and taken up in the stream of time. Any (human) pursuit of a stat- ed "aim" is a simplification, and a departure from reality.' The lessons of Cage were developed further by an American ‘second generation' around 1960. And once again the aesthetic consequences of the concept of indetermination were applied more radically than in Europe. In the work of La Monte Young, Terry Riley, Robert Ashley and the Fluxus Movement, almost all existing values and concepts relating to music were turned well and truly upside down. La Monte Young (1935) worked with long chains of chords that developed systematically. His material is economical, and naturally comprises all that is 'sound', including that produced by nature, machines, and electronic resources. Performances may last a week or more and incorporate other ele- ments such as light, movement and theatre. His contemporary Terry Riley followed the same course. His music consists of long chains of repeated motifs, usually in elementary diatonic note patterns. Tape loops and feedback systems provide the characteristic tone colours; electronic and instrumental resources merge. These and other Americans shared a broad interest in wide- ly different idioms including jazz, pop and non-Western music. Chance action - indetermination: many composers throughout the world now work within these borders. Only few are conscious of the background so brilliantly evoked by Cage in his writings. What is clear, however, is that serial concepts are disappearing; there is a growing reaction to their abstrac- tions and a tendency towards greater directness in music making. This is also expressed in the instrumental works of Berio, Ligeti, Kagel and others: music that is tailor-made for certain specialists, musicians who are required to make a creative contribution of their own rather than only faithfully reproduce a more or less authoritarian score. Such music renounces serial, abstractly deter- mined sound differentiation in favour of a more direct form of expression. Not only the actual notes, but sighs, scratches, shouts and moans become part of music making. The instrument literally becomes an extension of the human body. Similar tendencies are found in music theatre. This rather vague term embodies so much variety that a comprehensive definition can hardly be given. In general, it can be viewed as a reaction to traditional theatrical and operatic forms, which have caused the nineteenth century to live on, leaving current issues to the realm of film. The 'raree show' idea has also been aban- doned, since divisions between audience and stage, between different partic- ipating disciplines, required abolition. Various directions emerged, from the political engagement of Nono (Intolleranza, 1960) to the more light-hearted or autonomous approach of Kagel (Sur Scène, 1960) and Ligeti (Aventures, 1962). Nono connected with traditional opera, while Ligeti created a 'com- position with scenic, verbal and musical means'. Unlike the traditional Gesamtkunstwerk there is a tendency to grant the incorporated elements a life of their own, independent of one another and only joined by a common peri- od of time. Once again, vocal and instrumental techniques are extended to such a degree that the two flow together. All such innovations amount to repeated attempts to break through exist- ing boundaries! From the beginning of the twentieth century, the failure of instrument making to keep pace with musical developments made itself increasingly felt. Factories were usually highly industrialised, geared to the mass production of traditional instruments and leaving no room for altruis- tic research in an artistic sense. Today's composer must still make do with instruments developed hundreds of years ago: thus the continual expansion of playing techniques towards the boundaries of human endeavour; thus the contact microphones; and thus the ongoing specialisation of the few players devoted exclusively to new music. Use only the details found in the text above to inform your answer. Which composers are credited with creating and expanding the framework for aleatory composition in its early days?
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Use only the details found in the text above to inform your answer.
EVIDENCE:
8 In section 4 we discussed various tendencies that began to emerge during and after the phase of punctual music. Around 1956 these became much clearer and enabled composers to draw certain conclusions. 1. The statistical approach to music came to the foreground. The primary consideration became the ordering of higher categories of form rather than the organisation of detail. This was already indicated by use of the term 'group' to refer to what is really the smallest unit, characterised by the detailed effect of pitch, duration, timbre, etc.; within the group, however, a certain freedom was possible without encroaching on the characteristic of the group. This freedom was also evident in an easier use of interval proportions than was ever conceivable in classical dodecaphony. It was no longer a question of 'this and this' or 'so and so many notes, but of a certain degree of density. Density, register, direction of movement, degree of periodicity and many other concepts emerged as aspects of music that could be ordered serially. Attention to elements of detail made way for a more global determination, and thus for the concept of form. 2. In this process the series became increasingly neutral, functioning more and more as a regulatory factor. Proportions became decisive: a 3rd from a pitch series is a 5/4 proportion that can be manifest in any other musical ele- ment. In so far as pitch series were still employed, they likewise had a neutral character and were naturally no longer bound to the twelve notes. The series in Gruppen still had twelve notes, and indeed a pronounced shape of its own, presumably to attain large proportional contrasts in the macrofield. The Klavierstücke I-IV however, dating from 1954, retained only the rudiments of the 12-note series. In the second and third pieces, respectively, they are as fol- lows: Nono's Il Canto sospeso (1956) was based on the all-interval series shown in Example 109. Something similiar occurred in Messiaen's Livre d'Orgue (see Example 16). 3. The outstanding scholar Györgi Ligeti, who has already been mentioned, introduced the concept of interval permeability. In section 4 we have already observed how the interval, and indeed other musical elements too, lost its own existence by being taken up in higher, statistically determinable quanti- ties.4 This desensitisation evoked new problems and new possibilities. The music became manifest in layers, no longer characterised by the detail but by a global 'material state' (rough, granular, smooth, etc.). Such layers could be combined, and exact synchronisation was obviously no longer relevant. Indeed, exactness acquired a certain margin: synchronism was not essential, but rather the spatial distribution of 'material states'. Something of the sort had already been achieved by Messiaen, among others, with his modality, in which a certain indifferentiation likewise arose in terms of sequence of notes and intervals. In serial music composers went further: different tempos were combinable, and the new concept of field magnitude emerged, heralding another important phase in new music that is usually described as aleatory composition. 9 This did not appear out of thin air. Directly after the rigorously punctual style of the Structures, Boulez reacted with his Marteau sans Maître, completed in 1954, in which the tempo in particular fluctuates through the many changes, directions such as 'tempo et nuances très instables', etc. The work breathes a freedom and suppleness that reminds one immediately of Debussy. The many short notes, separate or clustered, and the irrational values create a sort of written-out rubato (see Example 35). This differentiation, which was also manifest, though somewhat differently, in Stockhausen's work of the same period, moved the latter to express the following thoughts (freely cited): 'An inaccuracy factor arises in performance. The areas within which this factor is manifest are time fields, and their dimensions are field magnitudes. In the past too this margin existed in performance, but was coincidental. Now we wish to capture these inaccuracies functionally. A series of field magnitudes, rather than a traditional series of fixated durations, can now be determinant.' This meant the abandonment of our quantitative system of fixed-value notation and the creation of a way of indicating the boundaries within which indeterminacy may occur, something that could be done in many ways. In Example 67 Boulez used the sign to indicate the boundaries within which a number of short notes may be freely placed. Stockhausen developed a different method to indicate action duration, based on the principle that note duration is no longer counted, but determined during performance by means of a particular action prescribed by the composer. Thus, the time between two notes, for instance, may depend on that required by the player to move his hand, on the degree of complexity of a given touch or pedal movement, or on breathing considerations, etc. Once again, such physiolog- ical reactions had always existed; but Stockhausen wished to incorporate them functionally in his music. Although it sounds paradoxical, all this revealed a desire to control musical elements that cannot be accurately com- mitted to paper. It is clear, therefore, that it was not a question of the absolute values of these elements, but of their mutual relationships. The rapidity of these innovations was remarkable. While the correspon- dence between macro- and micro-areas discussed in the previous sections was still hardly formulated, new territory was being explored. And each discovery required years of elaboration! Perhaps it was this hurried course of events that caused problems in Stockhausen's first composition in this field. Let us take a closer look at the Klavierstück XI of 1957. Nineteen groups are written down on a large piece of paper, all of very dif- ferent length and without any suggestion of sequence; some are illustrated in Example 110. According to the composer each group is in itself the result of serial ordering, based on different series to organise field magnitude propor- tions. We must take his word for it, since we have arrived at a situation in which serial manipulation can no longer be reconstructed without the help of the composer. Some groups include the familiar notes in small print that are to be played as fast as possible'. Action duration is taken into account, for the composer says that 'difficult chords and large leaps with one hand obviously require more time than simple chords and smaller intervals'. Although the notes in normal print have the customary quantitive notation of duration, an unexpected element is to play a role. Stockhausen prescribes the following: the performer is to glance unintentionally at the page and play the first group that catches his eye, in the tempo, dynamics and touch of his choice. The lat- ter, however, are classified by the composer beforehand: there are six tempos, for instance, ranging from tempo I, very fast, to tempo 6, very slow. Subsequently, the player's eye is caught unintentionally (without any attempt to connect particular groups) by another group which he now plays in accor- dance with directions given at the end of the previous group. Each group can be connected to any of the other eighteen, and all nineteen groups can there- fore be performed in the prescribed degrees of tempo, dynamics and touch. The characteristics of all groups are therefore variable within the chosen boundaries. The field magnitude of a following group is determined by indi- cations at the end of the preceding one. A performance does not necessarily include all the groups. If a group is repeated, indications are given for small modifications in the second render- ing, usually in the form of somewhat elementary octave transpositions. If a group occurs for a third time, it also brings one of the possible realisations of the whole piece to an end. The work is an example of open form, without direction or termination. The groups are spatially juxtaposed and can be com- bined in countless ways. In the many commentaries on this composition two aspects have been neglected or confused. 1. The action duration - a decidedly positive element. Instead of ‘counting' with a margin of inaccuracy, a spontaneous reaction arises, a realisation of the time structure at the moment of the action itself. Such music can therefore no longer be approached from the score, since the time structure is now deter- mined by the perception time of the performer himself, which is inseparable from physical reactions and abilities. Such freedom is therefore ostensible. Nothing is added to an existing structure (unlike jazz or basso continuo tech- nique); on the contrary, the player remains entirely bound to the composer's directions, but he becomes involved right down to his physical reactions. Notice that this action duration takes place within the boundaries of each group. The mutual bond between the groups is quite a different matter; it is created by means of what one could call: 2. the spontaneous decision. The player is required to glance 'unintention- ally' and to link the very first group that catches his eye with the preceding one. The word 'chance' crops up here and is indeed to stay with us, whether relevant or not. But it is not a question of chance, for the performer may choose from no more than the 18 options determined by the composer. All possibilities are already enclosed in the concept. At best there is mention of an unconsidered decision at the last moment - freedom, indeed, but a free- dom without sense. The actual time experience of the action duration is absent, as is the considered decision of the composition process. It is a free- dom that is only possible thanks to another concept of form, that of the open form without causality. These new concepts of form have already been dis- cussed at several points, especially in relation to the theory of musical space. In this light Stockhausen's Klavierstück XI is hardly new, but merely a confir- mation of a concept of form already found in Debussy. Stockhausen's step was to transfer choice from the composer to the per- former; instead of a single notated version, many realisations of a piece become feasible. - Boulez was the first to recognise the real problem of the Klavierstück XI. In the same period, but independently of Stockhausen, he worked on his Third Piano Sonata; at the same time he was confronted by the work of Mallarmé, whose literary preoccupations ran remarkably parallel despite the great dis- parity in time. In Boulez, too, the player gains a more important role, but this does nothing the composer believes - to change the problem of form. He felt the necessity to develop a new form that adapts to the material available to the serial composer, which was constantly becoming more elastic. But form to Boulez was something more than the mosaics of Stockhausen's music, which were really nothing other than constantly changing combinations from millions of options. If the performer was free to choose, then his choice should preferably be made after some consideration, and with only a very lim- ited number of possibilities that were precisely determined by the composer. An example is the overall structure of the Sonata (comprising five move- ments in the first concept): Antiphonie, Trope, Constellation, Strophe, Séquence. The sequence of the movements is free, providing that Constellation is always in the middle. The internal structure reflects the same approach. One of the movements, Trope, has four components: two so-called structures complexes (Parenthèse, Commentaire) and two structures simples (Glose, Texte). In the 'complex structures' the performer is again free to include or omit certain additional variants (given between brackets). The sequence of these components is indicated in an ingenious manner. The unnumbered pages of the score are in a ring binder, and the player may begin where he wishes. The sequence is therefore directed - we usually read from front to back - but not predetermined (Boulez speaks of a forme circu- laire). There are normally four options, therefore, depending on the starting point: - P, C, C, G, T G, T, P G, T, P C T, P, C, G But since the Commentaire section is included twice, four other possibilities become available, depending on where this section is placed (it may only be performed once); this can be represented as in Figure 7. Altogether eight dif- ferent sequences are therefore available; compared to the millions in Stockhausen, this illustrates just how much more control the composer has retained over the final outcome. The Trope from Boulez's Third Piano Sonata provided only a first and simple answer to the new problems of form. Although the composer already estab- lished new structural concepts, the territory as such was as yet hardly explored. This is particularly evident if we bear in mind that the free sequence of sections, which caused the most sensation in the beginning, was merely one aspect of the complex concept of form that awaited exploitation. However the case may be, through these preoccupations, form acquired unprecedented autonomy, despite the astonishing authority granted (for the time being) to the performer. This is already observed in the work of Mallarmé, who concentrated far more on the structure of language than on its significance, or, in other words, attempted to convert this significance into a symbolism of absolute value. Form had a life of its own, bringing the artist to an attitude of anonymity, since the intrusion of purely personal incidents was undesirable. Those with some knowledge of Asian culture will hardly be surprised by this. But in Europe relationships are different, and particularly for those less gifted than Boulez it is fitting to recall the words of Paul Valéry, a confidant of Mallarmé. Concerning the latter's ambitions he spoke later (in his Lettre sur Mallarme) of 'diviniser la chose écrite' (divining that which is written). But, he went on, 'ce n'est point l'œuvre faite et ses apparences ou ses effets dans le monde qui peuvent nous accomplir et nous édifier, mais seule- ment la manière dont nous l'avons faite (it is not the finished work and its appearances, or its effects on the world, which can fulfill and edify us, but only the manner in which we have accomplished it). IO The concept of aleatory music has now broadened considerably, and we must certainly mention one other composer under this heading. We have already examined two aspects: action duration and the sponta- neous decision in Stockhausen, and intervention possibilities in Boulez. In the latter the performer is like a driver who may choose from a limited num- ber of roads, while the road map itself remains the domain of the town plan- ner. Boulez described Stockhausen's solution as chance, while Stockhausen used the term gelenkter Zufall (guided chance); but as we have seen, in reali- ty the element of chance was less present than one might imagine. All this only made the problem of form most acute, and the composer who was to draw particularly radical conclusions was the American John Cage. Cage came to Europe in 1958 - I remember a momentous concert at the World Exhibition in Brussels - and was quick to cause the necessary stir. From his point of view our controversy between tonality and atonality was long out- dated. He believed that modern serialists kept far too much to traditional paths, exposing themselves to a constant risk of academicism. A number of similarities, however, can also be found. Like Boulez, Cage's music reveals a pursuit of objectivity, or rather anonymity, which helps the sound to 'come to itself'. But his conclusions were much more radical. Instead of trying to bind the notes, his school attempted to soak off their adhesive, formed as it was by centuries of convention. If one hangs on to the notes, if one has 'musical' ideas, one cannot allow the notes to be themselves. And 'being themselves' means that there is no superimposed expression. (Many modern composers would go along with him up to this point, and the much older Varèse, with his 'liberation of the sound', was even a precursor.) And it also means that there is no man-made organisation. Thus, Cage reached a conclusion diametrically opposed to our early serialists: not com- plete determination, but rather complete indetermination was essential. (One of the most shocking experiences of recent times is to discover that both points of departure lead to the same degree of indetermination.) In order to achieve this indetermination, Cage used to make particular use of chance actions such as the tossing of coins, etc. Other means may also be employed, such as the oracle of the staves from the ancient Chinese book I-Ching (which illustrates the influence of Zen Buddhism on this composer), or mathemati- cal methods. More recently, however, the accent has shifted towards the unforeseeable- ness of the performance itself, involving the actual performers. It is remark- able how completely different paths form striking parallels with modern European composers! Fifty years earlier Charles Ives, following quite a differ- ent line of thought, created the same sort of music as that of the young Schönberg and Stravinsky. Despite the shift towards live performance, a score was naturally still required as an instruction for the players. But the score must not be viewed as a ready-made, notated form. And this is where Cage differs: the composition is not an autonomous object, but a performance process. Obviously, this process has its boundaries - determined by the action of the players and by a number of characteristics - but essentially the music has no precedence above either note or noise. While it does have its own exis- tence, it remains 'transparent' in relation to its surroundings. Its boundaries become diffuse, and counting is not required, for we exist in time'. Stopwatches rather than bars serve to indicate when an occurrence of sound must take place within this time. Christian Wolff, a composer from the Cage group, replaced Stockhausen's eye ('unintentional glancing') with the ear: cer- tain occurrences of sound, caused by the one player, evoke reactions from the other (Duo for Pianists II). The outcome is determined by the performers themselves; finally, musical form may be conceived as 'the length of the pro- gramme'.7 Cage is among those Westerners who have listened to the Japanese bow- 8 man in chapter 6. Just how far his interpretation is correct, we will leave to the experts. Is this still music? Surely we see an influence on contemporary music that cannot be underestimated. Can everybody do the same? But not everybody does, is Cage's reply. Strong differences of opinion emerge. It is impossible to imagine the fascinating whirlpool of new developments with- out Cage. Whether the music comes from inside or outside, we cannot escape it. 'One day when the windows were open, Christian Wolff played one of his pieces at the piano. Sounds of traffic, boat horns, were heard not only during the silences in the music but, being louder, were more easily heard than the piano sounds themselves. Afterwards, someone asked Christian Wolff to play the piece again with the windows closed. Christian Wolff said he'd be glad to, but that it wasn't really necessary, since the sounds of the environment were in no sense an interruption of those of the music.' II The above discussion helps us to clarify the concept of aleatory music. It is a generic term for all aspects of music that are not predetermined. The rela- tionship between determined and undetermined elements plays a role in all types of music. The undetermined element brings unforeseeableness with it, and can occur both in performance and during the process of composition. Unforeseeableness can be manifest in differing degrees. In the perform- ance of a classical composition, for example, the degree to which the fixated notation can be deviated from is limited. Performance of a piece by John Cage, on the other hand, can involve a high degree of unforeseeableness. But even here general patterns of expectation can be formulated. Finally, with regard to developments in the music of the period 1950-60, the following aspects are of importance: more 1. In Cage's work the element of chance to use this dubious word once - was a means to obtain indetermination and to escape from the human grasp of the music. Young European composers, on the other hand, were con- cerned with gaining even stricter control of the musical material: even this indeterminable area of free choice was consciously incorporated in the of composition. process 2. Bearing in mind changing concepts of musical form, we can say that part of what once belonged to the individual and 'unique' work of art is now ascribed to the material employed by the performers. There is a certain incli- nation to make matters absolute, which corresponds logically to the excessive attention given to musical material that we have observed from 1950 onwards. 3. Expansionism, moreover, is not foreign to serial technique, in the sense that there is an inclination to exploit all the possibilities of the chosen mate- rial. The limited means of dodecaphony of the past have been extended to become an all-embracing permutation procedure; it soon became apparent, however, that this again was not sufficient to harness the wealth of resources that had been rallied. A written serial score realises only a few of the count- less possibilities, and the free choice of the performer can at least compensate this to a certain extent. The element of chance becomes a wider margin in the realisation of the (unforeseeable) permutation process. Far from coincidental is the attendant departure from the unique, once-and-for-all determined work of art. A remarkable dichotomy seems to arise between the realised con- dition of a single work of art and the 'possibly realisable' that is potentially present in the same. Here creative expansionism collides with ultimate boundaries. 4. The element of chance can serve to fill another gap. With all due respect for their sometimes brilliant ideas, one can nonetheless consider that both Stockhausen and Boulez have maintained an only too simple notion of the role of what they call 'surprise' in the musical process. The former wrote: "The degree of information is therefore at its highest when at any point in a musi- cal discourse the moment of surprise is at its strongest: the music constantly has "something to say". (Just before this he specifies: 'Surprise only occurs when the unexpected happens.')" Boulez shares this opinion: "... for any music that is a masterpiece is a music that allows the capacity to surprise at any moment. This is not the place to contradict these ideas, but it is clear that from this point of view too, the involvement of the spontaneous decision of the per- former is most welcome: the 'surprise' within the boundaries of a work may increase, and the same goes for each subsequent performance. 5. Increasing differentiation posed considerable problems with regard to traditional notation, which was not at all equal to its task. By involving the performer, this difficulty was eased on the one hand, while on the other new symbols had to be introduced to indicate players' actions. It was inevitable that this issue also had to be tackled once more, as is described in section 14. 12 In the reaction against abstractions, serial music lost more and more influence after 1960. Boulez has remained a bastion of serial academicism, but Stockhausen has changed enormously. He is no longer the great renewer, but continues to react with great flexibility to any external stimulus that he encounters. He is long past the stage of solving problems of form and tech- nique. From Carré (1960) and Originale (1961) onwards his work comprises. ever more heterogeneous elements including happenings, pop, quotations, indeterminate sound production (contact microphones), etc. The use of contact microphones has now become very widespread, and this opens up a new direction in the application of electronic resources. In days past, electronic music was accurately recorded on tape in a studio. Many considered this an advantage: the composer exercised maximum control, while the inconstancies of live performance were eliminated. But this strict view could not be maintained, and in a next step (discussed in section 9) aleatory techniques were introduced, at first very cautiously among Europeans but after 1960 much more freely. Improvisation groups even appeared on stage working with electronic apparatus. The principle is simple: microphones attached to 'instruments' (that may or may not be recognisable as such) pick up vibrations that are normally neither audible nor usable and feed them to loudspeakers via amplifiers and possibly modulators. A new and hitherto unknown world of sound is brought to life. Unexpected surprises may occur too, and with them an immediate response from the performer. This was a typical feature of the post-1960 period. exper- Once again it was Cage who led the way with such experiments. More important, however, was his awareness of the situation. For in his first iments with chance phenomena he discovered that he was still attempting to drag 'successful' results out of chance actions. Realising later on that this atti- tude was equivocal, he came to accept the induced results of chance. The result was no longer important, but rather the attitude of open-mindedness. Thus, he came to distinguish between chance actions and indetermination. In the first case the composer employs chance as a means, but to a limited degree such that he remains within a self-determined global circle. Indetermination, on the contrary, exceeds this circle: the result is in every respect indefinite; such music crops up out of time, undefined and inciden- tal, only to disappear once more without a trace. All things are interrelated,' Cage said, and taken up in the stream of time. Any (human) pursuit of a stat- ed "aim" is a simplification, and a departure from reality.' The lessons of Cage were developed further by an American ‘second generation' around 1960. And once again the aesthetic consequences of the concept of indetermination were applied more radically than in Europe. In the work of La Monte Young, Terry Riley, Robert Ashley and the Fluxus Movement, almost all existing values and concepts relating to music were turned well and truly upside down. La Monte Young (1935) worked with long chains of chords that developed systematically. His material is economical, and naturally comprises all that is 'sound', including that produced by nature, machines, and electronic resources. Performances may last a week or more and incorporate other ele- ments such as light, movement and theatre. His contemporary Terry Riley followed the same course. His music consists of long chains of repeated motifs, usually in elementary diatonic note patterns. Tape loops and feedback systems provide the characteristic tone colours; electronic and instrumental resources merge. These and other Americans shared a broad interest in wide- ly different idioms including jazz, pop and non-Western music. Chance action - indetermination: many composers throughout the world now work within these borders. Only few are conscious of the background so brilliantly evoked by Cage in his writings. What is clear, however, is that serial concepts are disappearing; there is a growing reaction to their abstrac- tions and a tendency towards greater directness in music making. This is also expressed in the instrumental works of Berio, Ligeti, Kagel and others: music that is tailor-made for certain specialists, musicians who are required to make a creative contribution of their own rather than only faithfully reproduce a more or less authoritarian score. Such music renounces serial, abstractly deter- mined sound differentiation in favour of a more direct form of expression. Not only the actual notes, but sighs, scratches, shouts and moans become part of music making. The instrument literally becomes an extension of the human body. Similar tendencies are found in music theatre. This rather vague term embodies so much variety that a comprehensive definition can hardly be given. In general, it can be viewed as a reaction to traditional theatrical and operatic forms, which have caused the nineteenth century to live on, leaving current issues to the realm of film. The 'raree show' idea has also been aban- doned, since divisions between audience and stage, between different partic- ipating disciplines, required abolition. Various directions emerged, from the political engagement of Nono (Intolleranza, 1960) to the more light-hearted or autonomous approach of Kagel (Sur Scène, 1960) and Ligeti (Aventures, 1962). Nono connected with traditional opera, while Ligeti created a 'com- position with scenic, verbal and musical means'. Unlike the traditional Gesamtkunstwerk there is a tendency to grant the incorporated elements a life of their own, independent of one another and only joined by a common peri- od of time. Once again, vocal and instrumental techniques are extended to such a degree that the two flow together. All such innovations amount to repeated attempts to break through exist- ing boundaries! From the beginning of the twentieth century, the failure of instrument making to keep pace with musical developments made itself increasingly felt. Factories were usually highly industrialised, geared to the mass production of traditional instruments and leaving no room for altruis- tic research in an artistic sense. Today's composer must still make do with instruments developed hundreds of years ago: thus the continual expansion of playing techniques towards the boundaries of human endeavour; thus the contact microphones; and thus the ongoing specialisation of the few players devoted exclusively to new music.
USER:
Which composers are credited with creating and expanding the framework for aleatory composition in its early days?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 13 | 17 | 4,878 | null | 471 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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Is the Government of the United States legally obligated to prosecute war crimes committed outside its borders, regardless if the victims are citizens of the United States? What changes to existing laws are mentioned in the text? What two examples are provided in the text to show the limitations of the War Crimes Act of 1996 and who signed it into effect? Who signed the 2023 war crimes bill into effect?
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Passed following an address by Ukraine’s leader and signed into the law in January 2023, the Justice for Victims of War Crimes Act authorizes the U.S. Justice Department to prosecute foreign nationals in the United States who are suspected of war crimes, even if the victims were not Americans, or the crimes were committed abroad. This blog post covers the legislation’s changes from its predecessor before discussing its significance in expanding U.S. prosecutorial power over international war crimes. On January 5, 2023, U.S. President Joe Biden signed into law the Justice for Victims of War Crimes Act, after it was introduced three months into the Russian invasion of Ukraine. This law expands the scope of federal prosecution power for international war crimes by authorizing the U.S. Department of Justice to prosecute suspected war criminals who are in the United States, regardless of the nationality of the victim or the perpetrator, or where the crime was committed. The unanimous and speedy Congressional approval of the bill came one day after Ukrainian President Volodymyr Zelenskyy’s joint address to the Congress, where he condemned the atrocities committed by President Vladimir Putin’s Russia and appealed for bipartisan support for his country. History of U.S. Prosecution Over War Crimes This law marks an important expansion of the U.S. prosecutorial power over international war crimes. Its predecessor, the War Crimes Act (18 U.S.C. § 2441), was signed into law in 1996 by President Bill Clinton and allowed the prosecution of war crime offenses committed anywhere, whether inside or outside of the United States if the victim or offender was a U.S. national or service member. This meant that war crimes committed outside of the United States against non-U.S. citizens were not justiciable in the United States, even if the perpetrators were residing in the country. Under the former law, Russian troops in Ukraine, committing war crimes against Ukrainians, would have been able to evade prosecution for their crimes abroad, even if they were to enter the United States. This limited jurisdiction effectively rendered the 1996 law a “dead letter” law, as there was not a single prosecution based on the statute in the 26 years since its enactment. Instead, the United States has only been able to resort to its immigration and counterterrorism laws to bring forward charges against those suspected of war crimes. Notably, the man known as the “General Dragon Master,” accused of committing atrocities during the Second Liberian Civil War, was only charged with using a fraudulently-obtained immigration document instead of being held accountable for his war crimes. Similarly, a federal judge was only able to sentence a commander of the Dos Erres Massacre Squad under charges of naturalization fraud rather than the atrocities he committed. The loopholes embedded in the 1996 War Crimes Act have essentially allowed these individuals to treat the United States as a safe haven where they can live and travel without the threat of domestic prosecution. Changes and Developments Under the New War Crimes Act The new law closes the legal loophole under the former War Crimes Act by broadening federal jurisdiction over alleged war criminals regardless of their nationality or the location of the offenses, as long as they are located within U.S. territory. This would allow the United States to prosecute war crimes committed in Ukraine if the perpetrators were to enter the country and sufficient evidence is gathered to support an indictment. The expanded jurisdiction may be particularly poignant in the possible scenarios in modern warfare where non-Americans belonging to military groups or contractors may be based in the United States while orchestrating, directing or aiding in the commission of war crimes overseas.
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[question] Is the Government of the United States legally obligated to prosecute war crimes committed outside its borders, regardless if the victims are citizens of the United States? What changes to existing laws are mentioned in the text? What two examples are provided in the text to show the limitations of the War Crimes Act of 1996 and who signed it into effect? Who signed the 2023 war crimes bill into effect? ===================== [text] Passed following an address by Ukraine’s leader and signed into the law in January 2023, the Justice for Victims of War Crimes Act authorizes the U.S. Justice Department to prosecute foreign nationals in the United States who are suspected of war crimes, even if the victims were not Americans, or the crimes were committed abroad. This blog post covers the legislation’s changes from its predecessor before discussing its significance in expanding U.S. prosecutorial power over international war crimes. On January 5, 2023, U.S. President Joe Biden signed into law the Justice for Victims of War Crimes Act, after it was introduced three months into the Russian invasion of Ukraine. This law expands the scope of federal prosecution power for international war crimes by authorizing the U.S. Department of Justice to prosecute suspected war criminals who are in the United States, regardless of the nationality of the victim or the perpetrator, or where the crime was committed. The unanimous and speedy Congressional approval of the bill came one day after Ukrainian President Volodymyr Zelenskyy’s joint address to the Congress, where he condemned the atrocities committed by President Vladimir Putin’s Russia and appealed for bipartisan support for his country. History of U.S. Prosecution Over War Crimes This law marks an important expansion of the U.S. prosecutorial power over international war crimes. Its predecessor, the War Crimes Act (18 U.S.C. § 2441), was signed into law in 1996 by President Bill Clinton and allowed the prosecution of war crime offenses committed anywhere, whether inside or outside of the United States if the victim or offender was a U.S. national or service member. This meant that war crimes committed outside of the United States against non-U.S. citizens were not justiciable in the United States, even if the perpetrators were residing in the country. Under the former law, Russian troops in Ukraine, committing war crimes against Ukrainians, would have been able to evade prosecution for their crimes abroad, even if they were to enter the United States. This limited jurisdiction effectively rendered the 1996 law a “dead letter” law, as there was not a single prosecution based on the statute in the 26 years since its enactment. Instead, the United States has only been able to resort to its immigration and counterterrorism laws to bring forward charges against those suspected of war crimes. Notably, the man known as the “General Dragon Master,” accused of committing atrocities during the Second Liberian Civil War, was only charged with using a fraudulently-obtained immigration document instead of being held accountable for his war crimes. Similarly, a federal judge was only able to sentence a commander of the Dos Erres Massacre Squad under charges of naturalization fraud rather than the atrocities he committed. The loopholes embedded in the 1996 War Crimes Act have essentially allowed these individuals to treat the United States as a safe haven where they can live and travel without the threat of domestic prosecution. Changes and Developments Under the New War Crimes Act The new law closes the legal loophole under the former War Crimes Act by broadening federal jurisdiction over alleged war criminals regardless of their nationality or the location of the offenses, as long as they are located within U.S. territory. This would allow the United States to prosecute war crimes committed in Ukraine if the perpetrators were to enter the country and sufficient evidence is gathered to support an indictment. The expanded jurisdiction may be particularly poignant in the possible scenarios in modern warfare where non-Americans belonging to military groups or contractors may be based in the United States while orchestrating, directing or aiding in the commission of war crimes overseas. https://www.jtl.columbia.edu/bulletin-blog/expanding-us-prosecutorial-power-over-international-war-crimes ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
Passed following an address by Ukraine’s leader and signed into the law in January 2023, the Justice for Victims of War Crimes Act authorizes the U.S. Justice Department to prosecute foreign nationals in the United States who are suspected of war crimes, even if the victims were not Americans, or the crimes were committed abroad. This blog post covers the legislation’s changes from its predecessor before discussing its significance in expanding U.S. prosecutorial power over international war crimes. On January 5, 2023, U.S. President Joe Biden signed into law the Justice for Victims of War Crimes Act, after it was introduced three months into the Russian invasion of Ukraine. This law expands the scope of federal prosecution power for international war crimes by authorizing the U.S. Department of Justice to prosecute suspected war criminals who are in the United States, regardless of the nationality of the victim or the perpetrator, or where the crime was committed. The unanimous and speedy Congressional approval of the bill came one day after Ukrainian President Volodymyr Zelenskyy’s joint address to the Congress, where he condemned the atrocities committed by President Vladimir Putin’s Russia and appealed for bipartisan support for his country. History of U.S. Prosecution Over War Crimes This law marks an important expansion of the U.S. prosecutorial power over international war crimes. Its predecessor, the War Crimes Act (18 U.S.C. § 2441), was signed into law in 1996 by President Bill Clinton and allowed the prosecution of war crime offenses committed anywhere, whether inside or outside of the United States if the victim or offender was a U.S. national or service member. This meant that war crimes committed outside of the United States against non-U.S. citizens were not justiciable in the United States, even if the perpetrators were residing in the country. Under the former law, Russian troops in Ukraine, committing war crimes against Ukrainians, would have been able to evade prosecution for their crimes abroad, even if they were to enter the United States. This limited jurisdiction effectively rendered the 1996 law a “dead letter” law, as there was not a single prosecution based on the statute in the 26 years since its enactment. Instead, the United States has only been able to resort to its immigration and counterterrorism laws to bring forward charges against those suspected of war crimes. Notably, the man known as the “General Dragon Master,” accused of committing atrocities during the Second Liberian Civil War, was only charged with using a fraudulently-obtained immigration document instead of being held accountable for his war crimes. Similarly, a federal judge was only able to sentence a commander of the Dos Erres Massacre Squad under charges of naturalization fraud rather than the atrocities he committed. The loopholes embedded in the 1996 War Crimes Act have essentially allowed these individuals to treat the United States as a safe haven where they can live and travel without the threat of domestic prosecution. Changes and Developments Under the New War Crimes Act The new law closes the legal loophole under the former War Crimes Act by broadening federal jurisdiction over alleged war criminals regardless of their nationality or the location of the offenses, as long as they are located within U.S. territory. This would allow the United States to prosecute war crimes committed in Ukraine if the perpetrators were to enter the country and sufficient evidence is gathered to support an indictment. The expanded jurisdiction may be particularly poignant in the possible scenarios in modern warfare where non-Americans belonging to military groups or contractors may be based in the United States while orchestrating, directing or aiding in the commission of war crimes overseas.
USER:
Is the Government of the United States legally obligated to prosecute war crimes committed outside its borders, regardless if the victims are citizens of the United States? What changes to existing laws are mentioned in the text? What two examples are provided in the text to show the limitations of the War Crimes Act of 1996 and who signed it into effect? Who signed the 2023 war crimes bill into effect?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 71 | 608 | null | 374 |
You are required to use only information provided in the prompt.
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Explain the responsibilities of each department during Mr. Taylor's disability claim. Use a separate paragraph for each department.
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Procedural History In 2007, Mr. Taylor filed a claim for service-connected disability benefits with VA. A VA medical examiner diagnosed Mr. Taylor with post-traumatic stress disorder (PTSD) resulting from his time at Edgewood, which was reaggravated during his time serving in Vietnam. Mr. Taylor was ultimately granted a total disability rating with an effective date of February 28, 2007, the day VA received his claim. VA relied on 38 U.S.C. § 5110 (implemented under 38 C.F.R. § 3.400) to establish this effective date. The provision specifies that, absent certain exceptions, the effective date for veterans benefits “shall not be earlier than the date of receipt of application therefor.” Mr. Taylor appealed the VA determination to the Board of Veterans’ Appeals (BVA) seeking an effective date of September 7, 1971, the day he was discharged from service. Mr. Taylor alleged that, since the secrecy oath prevented him from filing a claim, the effective date that he would have received in the absence of the oath should apply. The BVA, in July 2010, held that 38 U.S.C. § 5110 prevented the effective date for Mr. Taylor’s benefits from being any earlier than the day he filed his claim. The BVA stated that “there was nothing stopping [Mr. Taylor] from filing the claim . . . earlier and [VA] asking for a delay in the adjudication of the case following the obtaining of important evidence.” Mr. Taylor then appealed to the U.S. Court of Appeals for Veterans Claims (CAVC). In June 2013, the CAVC, in a single-judge decision, held that the BVA “failed to provide an adequate statement of reasons or bases for its . . . decision.” Specifically, the CAVC sought the language of the original secrecy oath. The CAVC vacated the BVA’s decision and remanded the case. The BVA, in February 2014, remanded the case to VA to ascertain the secrecy oath’s language and reassess the case. On remand, after VA procured a secrecy oath that most participants in the Edgewood program signed, VA and the BVA again concluded that Mr. Taylor was entitled to VA benefits starting February 28, 2007, the day VA received his claim, not September 7, 1971, the day he was discharged. The BVA made its determination in April 2017 and provided three reasons for its holding: (1) Mr. Taylor could have filed a disability claim earlier than 2007 premised on his experiences serving in Vietnam, which were partially responsible for his PTSD; (2) Mr. Taylor could have divulged his participation in the Edgewood program because he had done so on a previous occasion in pursuit of care, though the health care provider at that time did not believe him; and (3) Section 5110 delineates when VA benefits can begin and does not provide for equitable tolling (that is, exceptions to delineated time requirements to promote fairness). Mr. Taylor appealed to the CAVC for a second time. In April 2019, in a 2-1 decision, a panel of CAVC judges affirmed the BVA’s determination that Mr. Taylor was only entitled to VA disability benefits beginning February 28, 2007. The CAVC detailed three components of its analysis. First, Mr. Taylor was not entitled to relief under the Constitution’s Fifth Amendment Due Process Clause because he did not have a property interest in his VA benefits prior to February 28, 2007. Relying on Federal Circuit precedent, the CAVC held that individuals only gain a constitutionally cognizable property interest in VA benefits upon filing claims for such benefits. Second, the court determined that it lacked authority to provide Mr. Taylor with equitable relief by ordering VA to establish a process through which he and similarly situated veterans could establish effective dates for VA Congressional Research Service 3 benefits preceding their claim-filing dates. Third, the CAVC held that 38 U.S.C. § 5110 required the effective date for Mr. Taylor’s VA benefits to be February 28, 2007, the date he filed his claim. Mr. Taylor appealed the CAVC’s decision to the Federal Circuit. A three-judge Federal Circuit panel issued its opinion in June 2021, ruling in favor of Mr. Taylor. The court held the following: (1) “the Veterans Court may exercise such equitable powers, within the scope of its statutory jurisdiction, to ensure that all veterans entitled to benefits receive them” (that is, the CAVC had equitable powers beyond those specifically delineated by Congress); (2) the effective date requirement under 38 U.S.C. § 5110(a)(1) is not jurisdictional and can therefore be subject to equitable considerations and relief; (3) where “the Government has affirmatively and intentionally prevented” veterans from seeking medical care and VA benefits to which they are entitled under threat of criminal prosecution, the CAVC “is within its authority to hold the Government equitably estopped from asserting that those veterans are not entitled to an earlier effective date”; and (4) the government is equitably estopped from asserting 38 U.S.C. § 5110(a)(1) against Mr. Taylor because the government’s actions caused Mr. Taylor to file his benefits claim when he did. The Federal Circuit reversed the CAVC’s decision and remanded the case. In July 2021, however, the Federal Circuit voted to hear this case en banc. The full court heard oral argument on February 10, 2022, but weeks later, the U.S. Supreme Court granted review of Arellano v. McDonough, a case concerning whether 38 U.S.C. § 5110(b)(1), an exception to subsection (a)(1)’s requirements, is subject to equitable tolling. Section 5110(b)(1) mandates that “[t]he effective date of an award of disability compensation to a veteran shall be the day following the date of the veteran’s discharge or release if application therefor is received within one year from such date.” The Federal Circuit stayed all proceedings in Taylor until the Supreme Court decided Arellano. In January 2023, the Supreme Court held, in relevant part, that subsection (b)(1) is not subject to equitable tolling because “[t]he structure of §5110 reinforces Congress’s choice to set effective dates solely as prescribed in the text,” and because subsection (a)(1) provides “an instruction to attend to specifically enacted language to the exclusion of general, unenacted carveouts.” Following the Arellano decision, the Federal Circuit requested supplemental briefing by the parties in light of the Supreme Court’s holding. Taylor v. McDonough In June 2023, the full Federal Circuit decided in favor of Mr. Taylor. After finding equitable estoppel unavailable under Section 5110(a)(1) in light of Supreme Court precedent, the court held that the government violated Mr. Taylor’s constitutional right to due process under the Fifth Amendment. The court concluded that Mr. Taylor had “a constitutional right of access to adjudicatory forums” to vindicate his legal entitlements, and that the VA adjudicatory system and VA benefits are such a forum and entitlement, respectively. The Federal Circuit further held that the government unconstitutionally denied Mr. Taylor “access to the adjudication system of VA, the exclusive forum for securing his legal entitlement to the benefits at issue,” through the secrecy oath and threat of criminal prosecution for violating it. Thus, the court ruled that the relevant statutory limits on effective dates were “unconstitutional as applied” in Mr. Taylor’s case. The Federal Circuit determined that Mr. Taylor was entitled to “the effective date he would have had if no unconstitutional denial of access had occurred,” which could be September 7, 1971, the date Mr. Taylor was discharged, pending VA assessment of this issue on remand in accordance with the court’s decision. The Federal Circuit summarized its holding’s implications in the following terms: [W]hen a veteran has been determined to be entitled to benefits for one or more disabilities connected to participation in the Edgewood program at issue, the required effective date of such benefits is the date that the veteran would have had in the absence of the challenged government Congressional Research Service 4 conduct—imposition of the secrecy oath with no VA route for claim presentation and proof to vindicate the benefits entitlement. The court reversed the CAVC’s decision and remanded the case. The government has not sought Supreme Court review as of this writing, though it still has time to do so—petitions must be filed within 90 days of judgment.
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Explain the responsibilities of each department during Mr. Taylor's disability claim. Use a separate paragraph for each department. Procedural History In 2007, Mr. Taylor filed a claim for service-connected disability benefits with VA. A VA medical examiner diagnosed Mr. Taylor with post-traumatic stress disorder (PTSD) resulting from his time at Edgewood, which was reaggravated during his time serving in Vietnam. Mr. Taylor was ultimately granted a total disability rating with an effective date of February 28, 2007, the day VA received his claim. VA relied on 38 U.S.C. § 5110 (implemented under 38 C.F.R. § 3.400) to establish this effective date. The provision specifies that, absent certain exceptions, the effective date for veterans benefits “shall not be earlier than the date of receipt of application therefor.” Mr. Taylor appealed the VA determination to the Board of Veterans’ Appeals (BVA) seeking an effective date of September 7, 1971, the day he was discharged from service. Mr. Taylor alleged that, since the secrecy oath prevented him from filing a claim, the effective date that he would have received in the absence of the oath should apply. The BVA, in July 2010, held that 38 U.S.C. § 5110 prevented the effective date for Mr. Taylor’s benefits from being any earlier than the day he filed his claim. The BVA stated that “there was nothing stopping [Mr. Taylor] from filing the claim . . . earlier and [VA] asking for a delay in the adjudication of the case following the obtaining of important evidence.” Mr. Taylor then appealed to the U.S. Court of Appeals for Veterans Claims (CAVC). In June 2013, the CAVC, in a single-judge decision, held that the BVA “failed to provide an adequate statement of reasons or bases for its . . . decision.” Specifically, the CAVC sought the language of the original secrecy oath. The CAVC vacated the BVA’s decision and remanded the case. The BVA, in February 2014, remanded the case to VA to ascertain the secrecy oath’s language and reassess the case. On remand, after VA procured a secrecy oath that most participants in the Edgewood program signed, VA and the BVA again concluded that Mr. Taylor was entitled to VA benefits starting February 28, 2007, the day VA received his claim, not September 7, 1971, the day he was discharged. The BVA made its determination in April 2017 and provided three reasons for its holding: (1) Mr. Taylor could have filed a disability claim earlier than 2007 premised on his experiences serving in Vietnam, which were partially responsible for his PTSD; (2) Mr. Taylor could have divulged his participation in the Edgewood program because he had done so on a previous occasion in pursuit of care, though the health care provider at that time did not believe him; and (3) Section 5110 delineates when VA benefits can begin and does not provide for equitable tolling (that is, exceptions to delineated time requirements to promote fairness). Mr. Taylor appealed to the CAVC for a second time. In April 2019, in a 2-1 decision, a panel of CAVC judges affirmed the BVA’s determination that Mr. Taylor was only entitled to VA disability benefits beginning February 28, 2007. The CAVC detailed three components of its analysis. First, Mr. Taylor was not entitled to relief under the Constitution’s Fifth Amendment Due Process Clause because he did not have a property interest in his VA benefits prior to February 28, 2007. Relying on Federal Circuit precedent, the CAVC held that individuals only gain a constitutionally cognizable property interest in VA benefits upon filing claims for such benefits. Second, the court determined that it lacked authority to provide Mr. Taylor with equitable relief by ordering VA to establish a process through which he and similarly situated veterans could establish effective dates for VA Congressional Research Service 3 benefits preceding their claim-filing dates. Third, the CAVC held that 38 U.S.C. § 5110 required the effective date for Mr. Taylor’s VA benefits to be February 28, 2007, the date he filed his claim. Mr. Taylor appealed the CAVC’s decision to the Federal Circuit. A three-judge Federal Circuit panel issued its opinion in June 2021, ruling in favor of Mr. Taylor. The court held the following: (1) “the Veterans Court may exercise such equitable powers, within the scope of its statutory jurisdiction, to ensure that all veterans entitled to benefits receive them” (that is, the CAVC had equitable powers beyond those specifically delineated by Congress); (2) the effective date requirement under 38 U.S.C. § 5110(a)(1) is not jurisdictional and can therefore be subject to equitable considerations and relief; (3) where “the Government has affirmatively and intentionally prevented” veterans from seeking medical care and VA benefits to which they are entitled under threat of criminal prosecution, the CAVC “is within its authority to hold the Government equitably estopped from asserting that those veterans are not entitled to an earlier effective date”; and (4) the government is equitably estopped from asserting 38 U.S.C. § 5110(a)(1) against Mr. Taylor because the government’s actions caused Mr. Taylor to file his benefits claim when he did. The Federal Circuit reversed the CAVC’s decision and remanded the case. In July 2021, however, the Federal Circuit voted to hear this case en banc. The full court heard oral argument on February 10, 2022, but weeks later, the U.S. Supreme Court granted review of Arellano v. McDonough, a case concerning whether 38 U.S.C. § 5110(b)(1), an exception to subsection (a)(1)’s requirements, is subject to equitable tolling. Section 5110(b)(1) mandates that “[t]he effective date of an award of disability compensation to a veteran shall be the day following the date of the veteran’s discharge or release if application therefor is received within one year from such date.” The Federal Circuit stayed all proceedings in Taylor until the Supreme Court decided Arellano. In January 2023, the Supreme Court held, in relevant part, that subsection (b)(1) is not subject to equitable tolling because “[t]he structure of §5110 reinforces Congress’s choice to set effective dates solely as prescribed in the text,” and because subsection (a)(1) provides “an instruction to attend to specifically enacted language to the exclusion of general, unenacted carveouts.” Following the Arellano decision, the Federal Circuit requested supplemental briefing by the parties in light of the Supreme Court’s holding. Taylor v. McDonough In June 2023, the full Federal Circuit decided in favor of Mr. Taylor. After finding equitable estoppel unavailable under Section 5110(a)(1) in light of Supreme Court precedent, the court held that the government violated Mr. Taylor’s constitutional right to due process under the Fifth Amendment. The court concluded that Mr. Taylor had “a constitutional right of access to adjudicatory forums” to vindicate his legal entitlements, and that the VA adjudicatory system and VA benefits are such a forum and entitlement, respectively. The Federal Circuit further held that the government unconstitutionally denied Mr. Taylor “access to the adjudication system of VA, the exclusive forum for securing his legal entitlement to the benefits at issue,” through the secrecy oath and threat of criminal prosecution for violating it. Thus, the court ruled that the relevant statutory limits on effective dates were “unconstitutional as applied” in Mr. Taylor’s case. The Federal Circuit determined that Mr. Taylor was entitled to “the effective date he would have had if no unconstitutional denial of access had occurred,” which could be September 7, 1971, the date Mr. Taylor was discharged, pending VA assessment of this issue on remand in accordance with the court’s decision. The Federal Circuit summarized its holding’s implications in the following terms: [W]hen a veteran has been determined to be entitled to benefits for one or more disabilities connected to participation in the Edgewood program at issue, the required effective date of such benefits is the date that the veteran would have had in the absence of the challenged government Congressional Research Service 4 conduct—imposition of the secrecy oath with no VA route for claim presentation and proof to vindicate the benefits entitlement. The court reversed the CAVC’s decision and remanded the case. The government has not sought Supreme Court review as of this writing, though it still has time to do so—petitions must be filed within 90 days of judgment. You are required to use only information provided in the prompt.
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You are required to use only information provided in the prompt.
EVIDENCE:
Procedural History In 2007, Mr. Taylor filed a claim for service-connected disability benefits with VA. A VA medical examiner diagnosed Mr. Taylor with post-traumatic stress disorder (PTSD) resulting from his time at Edgewood, which was reaggravated during his time serving in Vietnam. Mr. Taylor was ultimately granted a total disability rating with an effective date of February 28, 2007, the day VA received his claim. VA relied on 38 U.S.C. § 5110 (implemented under 38 C.F.R. § 3.400) to establish this effective date. The provision specifies that, absent certain exceptions, the effective date for veterans benefits “shall not be earlier than the date of receipt of application therefor.” Mr. Taylor appealed the VA determination to the Board of Veterans’ Appeals (BVA) seeking an effective date of September 7, 1971, the day he was discharged from service. Mr. Taylor alleged that, since the secrecy oath prevented him from filing a claim, the effective date that he would have received in the absence of the oath should apply. The BVA, in July 2010, held that 38 U.S.C. § 5110 prevented the effective date for Mr. Taylor’s benefits from being any earlier than the day he filed his claim. The BVA stated that “there was nothing stopping [Mr. Taylor] from filing the claim . . . earlier and [VA] asking for a delay in the adjudication of the case following the obtaining of important evidence.” Mr. Taylor then appealed to the U.S. Court of Appeals for Veterans Claims (CAVC). In June 2013, the CAVC, in a single-judge decision, held that the BVA “failed to provide an adequate statement of reasons or bases for its . . . decision.” Specifically, the CAVC sought the language of the original secrecy oath. The CAVC vacated the BVA’s decision and remanded the case. The BVA, in February 2014, remanded the case to VA to ascertain the secrecy oath’s language and reassess the case. On remand, after VA procured a secrecy oath that most participants in the Edgewood program signed, VA and the BVA again concluded that Mr. Taylor was entitled to VA benefits starting February 28, 2007, the day VA received his claim, not September 7, 1971, the day he was discharged. The BVA made its determination in April 2017 and provided three reasons for its holding: (1) Mr. Taylor could have filed a disability claim earlier than 2007 premised on his experiences serving in Vietnam, which were partially responsible for his PTSD; (2) Mr. Taylor could have divulged his participation in the Edgewood program because he had done so on a previous occasion in pursuit of care, though the health care provider at that time did not believe him; and (3) Section 5110 delineates when VA benefits can begin and does not provide for equitable tolling (that is, exceptions to delineated time requirements to promote fairness). Mr. Taylor appealed to the CAVC for a second time. In April 2019, in a 2-1 decision, a panel of CAVC judges affirmed the BVA’s determination that Mr. Taylor was only entitled to VA disability benefits beginning February 28, 2007. The CAVC detailed three components of its analysis. First, Mr. Taylor was not entitled to relief under the Constitution’s Fifth Amendment Due Process Clause because he did not have a property interest in his VA benefits prior to February 28, 2007. Relying on Federal Circuit precedent, the CAVC held that individuals only gain a constitutionally cognizable property interest in VA benefits upon filing claims for such benefits. Second, the court determined that it lacked authority to provide Mr. Taylor with equitable relief by ordering VA to establish a process through which he and similarly situated veterans could establish effective dates for VA Congressional Research Service 3 benefits preceding their claim-filing dates. Third, the CAVC held that 38 U.S.C. § 5110 required the effective date for Mr. Taylor’s VA benefits to be February 28, 2007, the date he filed his claim. Mr. Taylor appealed the CAVC’s decision to the Federal Circuit. A three-judge Federal Circuit panel issued its opinion in June 2021, ruling in favor of Mr. Taylor. The court held the following: (1) “the Veterans Court may exercise such equitable powers, within the scope of its statutory jurisdiction, to ensure that all veterans entitled to benefits receive them” (that is, the CAVC had equitable powers beyond those specifically delineated by Congress); (2) the effective date requirement under 38 U.S.C. § 5110(a)(1) is not jurisdictional and can therefore be subject to equitable considerations and relief; (3) where “the Government has affirmatively and intentionally prevented” veterans from seeking medical care and VA benefits to which they are entitled under threat of criminal prosecution, the CAVC “is within its authority to hold the Government equitably estopped from asserting that those veterans are not entitled to an earlier effective date”; and (4) the government is equitably estopped from asserting 38 U.S.C. § 5110(a)(1) against Mr. Taylor because the government’s actions caused Mr. Taylor to file his benefits claim when he did. The Federal Circuit reversed the CAVC’s decision and remanded the case. In July 2021, however, the Federal Circuit voted to hear this case en banc. The full court heard oral argument on February 10, 2022, but weeks later, the U.S. Supreme Court granted review of Arellano v. McDonough, a case concerning whether 38 U.S.C. § 5110(b)(1), an exception to subsection (a)(1)’s requirements, is subject to equitable tolling. Section 5110(b)(1) mandates that “[t]he effective date of an award of disability compensation to a veteran shall be the day following the date of the veteran’s discharge or release if application therefor is received within one year from such date.” The Federal Circuit stayed all proceedings in Taylor until the Supreme Court decided Arellano. In January 2023, the Supreme Court held, in relevant part, that subsection (b)(1) is not subject to equitable tolling because “[t]he structure of §5110 reinforces Congress’s choice to set effective dates solely as prescribed in the text,” and because subsection (a)(1) provides “an instruction to attend to specifically enacted language to the exclusion of general, unenacted carveouts.” Following the Arellano decision, the Federal Circuit requested supplemental briefing by the parties in light of the Supreme Court’s holding. Taylor v. McDonough In June 2023, the full Federal Circuit decided in favor of Mr. Taylor. After finding equitable estoppel unavailable under Section 5110(a)(1) in light of Supreme Court precedent, the court held that the government violated Mr. Taylor’s constitutional right to due process under the Fifth Amendment. The court concluded that Mr. Taylor had “a constitutional right of access to adjudicatory forums” to vindicate his legal entitlements, and that the VA adjudicatory system and VA benefits are such a forum and entitlement, respectively. The Federal Circuit further held that the government unconstitutionally denied Mr. Taylor “access to the adjudication system of VA, the exclusive forum for securing his legal entitlement to the benefits at issue,” through the secrecy oath and threat of criminal prosecution for violating it. Thus, the court ruled that the relevant statutory limits on effective dates were “unconstitutional as applied” in Mr. Taylor’s case. The Federal Circuit determined that Mr. Taylor was entitled to “the effective date he would have had if no unconstitutional denial of access had occurred,” which could be September 7, 1971, the date Mr. Taylor was discharged, pending VA assessment of this issue on remand in accordance with the court’s decision. The Federal Circuit summarized its holding’s implications in the following terms: [W]hen a veteran has been determined to be entitled to benefits for one or more disabilities connected to participation in the Edgewood program at issue, the required effective date of such benefits is the date that the veteran would have had in the absence of the challenged government Congressional Research Service 4 conduct—imposition of the secrecy oath with no VA route for claim presentation and proof to vindicate the benefits entitlement. The court reversed the CAVC’s decision and remanded the case. The government has not sought Supreme Court review as of this writing, though it still has time to do so—petitions must be filed within 90 days of judgment.
USER:
Explain the responsibilities of each department during Mr. Taylor's disability claim. Use a separate paragraph for each department.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 11 | 18 | 1,344 | null | 498 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
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Researchers at Foch Hospital in France published this study of pregnancy outcomes in two groups of patients. Please summarize outcomes across the three kinds of complications that the researchers studied.
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Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications. Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old. Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis. Objectives The main objective of the study is to determine the incidence of obstetric, fetal, and neonatal complication and to assess whether age is an independent factor of these complications. The secondary objectives are to determine whether there is an association between some complications (pre-eclampsia, gestational diabetes, prematurity) and the conception mode associated with the type of pregnancy (singleton or twin). The obstetrical complications studied are gestational hypertension (defined as systolic >140 mmH and/or diastolic >90 mmHg without proteinuria), pre-eclampsia (systolic >140 mmHand/or diastolic >90 mmHg associated with a proteinuria of 24 h >300 mg), gestational diabetes (defined according to the recommendations of the 2015 CNGOF), cesarean section (CS), admission of women to the intensive care unit during their pregnancies, postpartum hemorrhage (loss of more than 500 cc of blood within 24 h after vaginal delivery or CS) and blood transfusion. The fetal complications studied are intrauterine growth retardation (IUGR) (defined as having an estimation of fetal weight <5e p) and fetal death in utero (FDIU). The neonatal complications studied were prematurity (birth before 37 weeks), pH at birth (acidosis with pH <7.10), APGAR score (<7), and pediatric care just after the birth. Discussion Our study shows that advanced maternal age is an independent risk factor for obstetric and neonatal complications (14, 15). In fact, multivariate analysis found significant results for three of the most common pregnancy-related diseases: gestational hypertension, pre-eclampsia, and gestational diabetes. Our large sample significantly confirms the occurrence of pre-eclampsia in women aged 40 and above, unlike some studies with small samples that did not find this result in multivariate analysis (3). Moreover, there is a higher risk of pre-eclampsia when the patient has some other risk factor such as twin pregnancy or medical history (hypertension and/or diabetes and/or VTE/vascular disease/lupus) (16, 17). Even more, these women with advanced maternal age are at higher risk of developing cardiovascular and nephrological diseases in the long term (18). In the case of tobacco, it has not been found as an independent risk factor, which can probably be explained by a significant underestimation of women reporting smoking during pregnancy. The high proportion of cesareans in the study group of women over 40 is due to some contributing factors. On one hand, the percentage of scheduled cesareans is higher because there is a higher prevalence of uni or multi-cicatricial uterus. Cesareans for high maternal age or for maternal request finally represented a small sample (22 women/1,982, 1% in the exposed group vs. 1/1,982 in the unexposed group). There was also a higher rate about the emergency cesareans deliveries in the study group over 40 years old. Several physiological hypotheses have been mentioned in previous studies (2, 3): a higher rate of dystocia presentation and scarred uterus, uterine contractility less effective than for a woman aged 25–35. In our sample, the most common indications for CS were abnormalities of cardio-fetal rhythm and cervical dystocia (19). It is likely that CFR abnormalities are more severely judged by the obstetrician, in the context of older patients, especially if the pregnancy is a result of ART, putting some women at a risk of cesarean that is not always justified (20). In total, this large proportion of CS in women 40 years and older has also been shown in other studies (3, 4, 17, 20–22). However, these results should be taken with caution because some indications for CS are inherent to the protocols practiced in our unit. The association between advanced maternal age and fetal deaths in utero should also be taken into account. Among those 43 FDIUs, we have looked at every medical files of those women and we did not find any events that could explained this high number. Indeed, among the 43 FDIUs in women aged 40 and above, there were no more patients using ART, nor more patients with obstetric pathology. This can be explained by a small number of FDIU. The only common point in our study group was the advanced maternal age. In these circumstances, instead of worrying the patients, it might be more appropriate to give them clear and reassuring information while performing a pre-conception close monitoring and throughout the pregnancy. This would help detect and manage these complications much earlier. In addition, with the advanced technology, several risks are now monitored using non-invasive prenatal screening or even the pre-implantation diagnosis (23–26). The incidence of maternal complications is likely to increase over time due to increased maternal age. It will be difficult to reduce the incidence of these complications, but we can reduce the serious complications of preeclampsia, gestational diabetes (such as eclampsia, and macrosomia) through appropriate management (induce delivery before 41 weeks, close monitoring of the fetus) (27, 28). With regard to neonatal complications, few significant differences were found in our study, as well as in the literature (29, 30). This is partly explained by the fact that several obstetrical factors can interfere without being related to age (the length of the delivery, abnormalities of the RCF, chorioamnionitis (3, 31, 32). Our study has several advantages. On the one hand, our study was done on a large sample, with data processing from medical records with a complete search for missing data. International and European studies with large samples use public health registers, thereby providing a lot of information on the characteristics of the population (5, 10). However, this is often at the expense of information such as the type of delivery, the methods of neonatology care which are sometimes different in hospitals. On the other hand, we took a period of 11 years, to check if there had been a difference in daily practices. We did not notice any difference between the periods 2006–2010 and 2011–2017 except for the increasing number of patients who have access to ART. On the other hand, we matched each patient aged 40 and above to a patient aged between 25 and 35 whose delivery number followed the patient case. Indeed, this allowed us to limit as far as possible all the variability of practices on the delivery route (natural delivery vs. cesarean, neonatal care). We also had the advantage of separating fetuses, newborns, and mothers, which has not been realized in other studies, and which may lead to a classification bias regarding perinatal outcomes. Our study is yet limited by its monocentric character and retrospective aspect. In addition, Foch Hospital has an ART center, so our sample probably contained more patients using these techniques. However, we had the opportunity to have 18.2% of women over 40 using ART. This allowed us to highlight the significant increase in preeclampsia and prematurity in patients over 40 years of age who have used ART. After 44 years, 1 out of 2 women used the ART. This rate is surely underestimated because there is a large number of patients who voluntarily omit to declare their use of ART in particular the use of donated oocytes (33). It is especially remembered that maternal complications occurring decades ago are less morbid today than before (22, 34). Screening and management of maternal and neonatal complications are progressively improving, and a high-risk pregnancy at age 40 in the 1980s should no longer discourage patients and obstetricians in 2020.
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Researchers at Foch Hospital in France published this study of pregnancy outcomes in two groups of patients. Please summarize outcomes across the three kinds of complications that the researchers studied. Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications. Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old. Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis. Objectives The main objective of the study is to determine the incidence of obstetric, fetal, and neonatal complication and to assess whether age is an independent factor of these complications. The secondary objectives are to determine whether there is an association between some complications (pre-eclampsia, gestational diabetes, prematurity) and the conception mode associated with the type of pregnancy (singleton or twin). The obstetrical complications studied are gestational hypertension (defined as systolic >140 mmH and/or diastolic >90 mmHg without proteinuria), pre-eclampsia (systolic >140 mmHand/or diastolic >90 mmHg associated with a proteinuria of 24 h >300 mg), gestational diabetes (defined according to the recommendations of the 2015 CNGOF), cesarean section (CS), admission of women to the intensive care unit during their pregnancies, postpartum hemorrhage (loss of more than 500 cc of blood within 24 h after vaginal delivery or CS) and blood transfusion. The fetal complications studied are intrauterine growth retardation (IUGR) (defined as having an estimation of fetal weight <5e p) and fetal death in utero (FDIU). The neonatal complications studied were prematurity (birth before 37 weeks), pH at birth (acidosis with pH <7.10), APGAR score (<7), and pediatric care just after the birth. Discussion Our study shows that advanced maternal age is an independent risk factor for obstetric and neonatal complications (14, 15). In fact, multivariate analysis found significant results for three of the most common pregnancy-related diseases: gestational hypertension, pre-eclampsia, and gestational diabetes. Our large sample significantly confirms the occurrence of pre-eclampsia in women aged 40 and above, unlike some studies with small samples that did not find this result in multivariate analysis (3). Moreover, there is a higher risk of pre-eclampsia when the patient has some other risk factor such as twin pregnancy or medical history (hypertension and/or diabetes and/or VTE/vascular disease/lupus) (16, 17). Even more, these women with advanced maternal age are at higher risk of developing cardiovascular and nephrological diseases in the long term (18). In the case of tobacco, it has not been found as an independent risk factor, which can probably be explained by a significant underestimation of women reporting smoking during pregnancy. The high proportion of cesareans in the study group of women over 40 is due to some contributing factors. On one hand, the percentage of scheduled cesareans is higher because there is a higher prevalence of uni or multi-cicatricial uterus. Cesareans for high maternal age or for maternal request finally represented a small sample (22 women/1,982, 1% in the exposed group vs. 1/1,982 in the unexposed group). There was also a higher rate about the emergency cesareans deliveries in the study group over 40 years old. Several physiological hypotheses have been mentioned in previous studies (2, 3): a higher rate of dystocia presentation and scarred uterus, uterine contractility less effective than for a woman aged 25–35. In our sample, the most common indications for CS were abnormalities of cardio-fetal rhythm and cervical dystocia (19). It is likely that CFR abnormalities are more severely judged by the obstetrician, in the context of older patients, especially if the pregnancy is a result of ART, putting some women at a risk of cesarean that is not always justified (20). In total, this large proportion of CS in women 40 years and older has also been shown in other studies (3, 4, 17, 20–22). However, these results should be taken with caution because some indications for CS are inherent to the protocols practiced in our unit. The association between advanced maternal age and fetal deaths in utero should also be taken into account. Among those 43 FDIUs, we have looked at every medical files of those women and we did not find any events that could explained this high number. Indeed, among the 43 FDIUs in women aged 40 and above, there were no more patients using ART, nor more patients with obstetric pathology. This can be explained by a small number of FDIU. The only common point in our study group was the advanced maternal age. In these circumstances, instead of worrying the patients, it might be more appropriate to give them clear and reassuring information while performing a pre-conception close monitoring and throughout the pregnancy. This would help detect and manage these complications much earlier. In addition, with the advanced technology, several risks are now monitored using non-invasive prenatal screening or even the pre-implantation diagnosis (23–26). The incidence of maternal complications is likely to increase over time due to increased maternal age. It will be difficult to reduce the incidence of these complications, but we can reduce the serious complications of preeclampsia, gestational diabetes (such as eclampsia, and macrosomia) through appropriate management (induce delivery before 41 weeks, close monitoring of the fetus) (27, 28). With regard to neonatal complications, few significant differences were found in our study, as well as in the literature (29, 30). This is partly explained by the fact that several obstetrical factors can interfere without being related to age (the length of the delivery, abnormalities of the RCF, chorioamnionitis (3, 31, 32). Our study has several advantages. On the one hand, our study was done on a large sample, with data processing from medical records with a complete search for missing data. International and European studies with large samples use public health registers, thereby providing a lot of information on the characteristics of the population (5, 10). However, this is often at the expense of information such as the type of delivery, the methods of neonatology care which are sometimes different in hospitals. On the other hand, we took a period of 11 years, to check if there had been a difference in daily practices. We did not notice any difference between the periods 2006–2010 and 2011–2017 except for the increasing number of patients who have access to ART. On the other hand, we matched each patient aged 40 and above to a patient aged between 25 and 35 whose delivery number followed the patient case. Indeed, this allowed us to limit as far as possible all the variability of practices on the delivery route (natural delivery vs. cesarean, neonatal care). We also had the advantage of separating fetuses, newborns, and mothers, which has not been realized in other studies, and which may lead to a classification bias regarding perinatal outcomes. Our study is yet limited by its monocentric character and retrospective aspect. In addition, Foch Hospital has an ART center, so our sample probably contained more patients using these techniques. However, we had the opportunity to have 18.2% of women over 40 using ART. This allowed us to highlight the significant increase in preeclampsia and prematurity in patients over 40 years of age who have used ART. After 44 years, 1 out of 2 women used the ART. This rate is surely underestimated because there is a large number of patients who voluntarily omit to declare their use of ART in particular the use of donated oocytes (33). It is especially remembered that maternal complications occurring decades ago are less morbid today than before (22, 34). Screening and management of maternal and neonatal complications are progressively improving, and a high-risk pregnancy at age 40 in the 1980s should no longer discourage patients and obstetricians in 2020. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00208/full
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications. Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old. Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis. Objectives The main objective of the study is to determine the incidence of obstetric, fetal, and neonatal complication and to assess whether age is an independent factor of these complications. The secondary objectives are to determine whether there is an association between some complications (pre-eclampsia, gestational diabetes, prematurity) and the conception mode associated with the type of pregnancy (singleton or twin). The obstetrical complications studied are gestational hypertension (defined as systolic >140 mmH and/or diastolic >90 mmHg without proteinuria), pre-eclampsia (systolic >140 mmHand/or diastolic >90 mmHg associated with a proteinuria of 24 h >300 mg), gestational diabetes (defined according to the recommendations of the 2015 CNGOF), cesarean section (CS), admission of women to the intensive care unit during their pregnancies, postpartum hemorrhage (loss of more than 500 cc of blood within 24 h after vaginal delivery or CS) and blood transfusion. The fetal complications studied are intrauterine growth retardation (IUGR) (defined as having an estimation of fetal weight <5e p) and fetal death in utero (FDIU). The neonatal complications studied were prematurity (birth before 37 weeks), pH at birth (acidosis with pH <7.10), APGAR score (<7), and pediatric care just after the birth. Discussion Our study shows that advanced maternal age is an independent risk factor for obstetric and neonatal complications (14, 15). In fact, multivariate analysis found significant results for three of the most common pregnancy-related diseases: gestational hypertension, pre-eclampsia, and gestational diabetes. Our large sample significantly confirms the occurrence of pre-eclampsia in women aged 40 and above, unlike some studies with small samples that did not find this result in multivariate analysis (3). Moreover, there is a higher risk of pre-eclampsia when the patient has some other risk factor such as twin pregnancy or medical history (hypertension and/or diabetes and/or VTE/vascular disease/lupus) (16, 17). Even more, these women with advanced maternal age are at higher risk of developing cardiovascular and nephrological diseases in the long term (18). In the case of tobacco, it has not been found as an independent risk factor, which can probably be explained by a significant underestimation of women reporting smoking during pregnancy. The high proportion of cesareans in the study group of women over 40 is due to some contributing factors. On one hand, the percentage of scheduled cesareans is higher because there is a higher prevalence of uni or multi-cicatricial uterus. Cesareans for high maternal age or for maternal request finally represented a small sample (22 women/1,982, 1% in the exposed group vs. 1/1,982 in the unexposed group). There was also a higher rate about the emergency cesareans deliveries in the study group over 40 years old. Several physiological hypotheses have been mentioned in previous studies (2, 3): a higher rate of dystocia presentation and scarred uterus, uterine contractility less effective than for a woman aged 25–35. In our sample, the most common indications for CS were abnormalities of cardio-fetal rhythm and cervical dystocia (19). It is likely that CFR abnormalities are more severely judged by the obstetrician, in the context of older patients, especially if the pregnancy is a result of ART, putting some women at a risk of cesarean that is not always justified (20). In total, this large proportion of CS in women 40 years and older has also been shown in other studies (3, 4, 17, 20–22). However, these results should be taken with caution because some indications for CS are inherent to the protocols practiced in our unit. The association between advanced maternal age and fetal deaths in utero should also be taken into account. Among those 43 FDIUs, we have looked at every medical files of those women and we did not find any events that could explained this high number. Indeed, among the 43 FDIUs in women aged 40 and above, there were no more patients using ART, nor more patients with obstetric pathology. This can be explained by a small number of FDIU. The only common point in our study group was the advanced maternal age. In these circumstances, instead of worrying the patients, it might be more appropriate to give them clear and reassuring information while performing a pre-conception close monitoring and throughout the pregnancy. This would help detect and manage these complications much earlier. In addition, with the advanced technology, several risks are now monitored using non-invasive prenatal screening or even the pre-implantation diagnosis (23–26). The incidence of maternal complications is likely to increase over time due to increased maternal age. It will be difficult to reduce the incidence of these complications, but we can reduce the serious complications of preeclampsia, gestational diabetes (such as eclampsia, and macrosomia) through appropriate management (induce delivery before 41 weeks, close monitoring of the fetus) (27, 28). With regard to neonatal complications, few significant differences were found in our study, as well as in the literature (29, 30). This is partly explained by the fact that several obstetrical factors can interfere without being related to age (the length of the delivery, abnormalities of the RCF, chorioamnionitis (3, 31, 32). Our study has several advantages. On the one hand, our study was done on a large sample, with data processing from medical records with a complete search for missing data. International and European studies with large samples use public health registers, thereby providing a lot of information on the characteristics of the population (5, 10). However, this is often at the expense of information such as the type of delivery, the methods of neonatology care which are sometimes different in hospitals. On the other hand, we took a period of 11 years, to check if there had been a difference in daily practices. We did not notice any difference between the periods 2006–2010 and 2011–2017 except for the increasing number of patients who have access to ART. On the other hand, we matched each patient aged 40 and above to a patient aged between 25 and 35 whose delivery number followed the patient case. Indeed, this allowed us to limit as far as possible all the variability of practices on the delivery route (natural delivery vs. cesarean, neonatal care). We also had the advantage of separating fetuses, newborns, and mothers, which has not been realized in other studies, and which may lead to a classification bias regarding perinatal outcomes. Our study is yet limited by its monocentric character and retrospective aspect. In addition, Foch Hospital has an ART center, so our sample probably contained more patients using these techniques. However, we had the opportunity to have 18.2% of women over 40 using ART. This allowed us to highlight the significant increase in preeclampsia and prematurity in patients over 40 years of age who have used ART. After 44 years, 1 out of 2 women used the ART. This rate is surely underestimated because there is a large number of patients who voluntarily omit to declare their use of ART in particular the use of donated oocytes (33). It is especially remembered that maternal complications occurring decades ago are less morbid today than before (22, 34). Screening and management of maternal and neonatal complications are progressively improving, and a high-risk pregnancy at age 40 in the 1980s should no longer discourage patients and obstetricians in 2020.
USER:
Researchers at Foch Hospital in France published this study of pregnancy outcomes in two groups of patients. Please summarize outcomes across the three kinds of complications that the researchers studied.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 30 | 1,410 | null | 26 |
For this task, you are required to answer questions using the information--and ONLY the information--provided as part of the prompt. Do NOT use any resources outside of this information to answer the questions,
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Give examples of how data analytics has changed the way baseball, basketball, and soccer are played.
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A core factor in fueling the widespread adoption of analytics in sports is the integration of technology. Although it is fairly straightforward to track all the action in a computer game, as they are ultimately mediated by lines of code and actions within the video game can be dumped into spreadsheets and databases for analysis, sports happen within a framework where the data must be collected before it can be assessed. In line with James’s early concerns about the poor state of play-by-play data in baseball, major sports leagues have invested greatly in the integration of technology to assess players and how they interact in games. Baseball pitches are tracked and the results compared with the strike zone to rate umpires. A company called Second Spectrum uses technology originally designed to track missiles to map how players move on basketball courts and soccer pitches, enabling comparative analysis about how players defend, run, and generally play the game. Catapult developed a wearable system that tracks how players stress their bodies during practice and games, aiding the ability to determine when players need a rest and when they are likely at the peak of their ability to perform. Technology has also become a means by which players, teams, and analysts can “directly engage in an active exploration to understand why and how such information may have emerged.”2 The combination of technologies to track sports makes them a bit more like a video game, where every data point is ready to be pulled into analysis. Increasing the data available to analysts creates a feedback loop, where the data can increase understanding to lead to new questions and new technological development in order to continue to refine the meta. Although there is likely to be a point of diminishing returns for both the technology and the analysis, that point will probably come when a sport is solved, which will make it far less interesting to watch and play. Baseball offers up an example of a sport that stands as a largely solved game, as analytics are widely accepted and their lessons frame strategy and play. Along the road toward solving a sport, data analysis leads to insights that change how certain teams play the game. When those teams overperform, their tactics are copied, frequently changing how the game is played and often upending decades of tradition in establishing a new “best” way to play. In baseball this shows up in defensive shifts where instead of dividing the field equally, defenders align themselves in a manner matched to where the hitter typically strikes the ball. In basketball, the three-point revolution took over as teams recognized that shots worth three points are expected to generate more points than long two-pointers and basically every shot other than those very close to the basket.3 In soccer, pressing dominates as elite teams noted that being able to win the ball high up the field makes them more likely to score and renders the opposition less likely to get a shot off. Football analytics found what Madden players had known for years, which is that going for it more often on fourth down increases offensive production (and is generally more fun). Throughout these changes, there is a back and forth as analytics debuts some new insight and established norms within the game resist. A strategy that is proven to be more effective in the long run does not take hold unless a coach or manager makes it to the long run in the first place by not getting fired. Short-run struggles, especially for those with novel approaches, can quickly leads to questions from the media and fans, potentially ending a career. For a new meta to really get established, it not only has to work, but it has to do so fairly quickly, and then as it spreads, it can become the new set of norms the next insight will have to overcome.
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system instruction: For this task, you are required to answer questions using the information--and ONLY the information--provided as part of the prompt. Do NOT use any resources outside of this information to answer the questions, question: Give examples of how data analytics has changed the way baseball, basketball, and soccer are played. context block: A core factor in fueling the widespread adoption of analytics in sports is the integration of technology. Although it is fairly straightforward to track all the action in a computer game, as they are ultimately mediated by lines of code and actions within the video game can be dumped into spreadsheets and databases for analysis, sports happen within a framework where the data must be collected before it can be assessed. In line with James’s early concerns about the poor state of play-by-play data in baseball, major sports leagues have invested greatly in the integration of technology to assess players and how they interact in games. Baseball pitches are tracked and the results compared with the strike zone to rate umpires. A company called Second Spectrum uses technology originally designed to track missiles to map how players move on basketball courts and soccer pitches, enabling comparative analysis about how players defend, run, and generally play the game. Catapult developed a wearable system that tracks how players stress their bodies during practice and games, aiding the ability to determine when players need a rest and when they are likely at the peak of their ability to perform. Technology has also become a means by which players, teams, and analysts can “directly engage in an active exploration to understand why and how such information may have emerged.”2 The combination of technologies to track sports makes them a bit more like a video game, where every data point is ready to be pulled into analysis. Increasing the data available to analysts creates a feedback loop, where the data can increase understanding to lead to new questions and new technological development in order to continue to refine the meta. Although there is likely to be a point of diminishing returns for both the technology and the analysis, that point will probably come when a sport is solved, which will make it far less interesting to watch and play. Baseball offers up an example of a sport that stands as a largely solved game, as analytics are widely accepted and their lessons frame strategy and play. Along the road toward solving a sport, data analysis leads to insights that change how certain teams play the game. When those teams overperform, their tactics are copied, frequently changing how the game is played and often upending decades of tradition in establishing a new “best” way to play. In baseball this shows up in defensive shifts where instead of dividing the field equally, defenders align themselves in a manner matched to where the hitter typically strikes the ball. In basketball, the three-point revolution took over as teams recognized that shots worth three points are expected to generate more points than long two-pointers and basically every shot other than those very close to the basket.3 In soccer, pressing dominates as elite teams noted that being able to win the ball high up the field makes them more likely to score and renders the opposition less likely to get a shot off. Football analytics found what Madden players had known for years, which is that going for it more often on fourth down increases offensive production (and is generally more fun). Throughout these changes, there is a back and forth as analytics debuts some new insight and established norms within the game resist. A strategy that is proven to be more effective in the long run does not take hold unless a coach or manager makes it to the long run in the first place by not getting fired. Short-run struggles, especially for those with novel approaches, can quickly leads to questions from the media and fans, potentially ending a career. For a new meta to really get established, it not only has to work, but it has to do so fairly quickly, and then as it spreads, it can become the new set of norms the next insight will have to overcome.
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For this task, you are required to answer questions using the information--and ONLY the information--provided as part of the prompt. Do NOT use any resources outside of this information to answer the questions,
EVIDENCE:
A core factor in fueling the widespread adoption of analytics in sports is the integration of technology. Although it is fairly straightforward to track all the action in a computer game, as they are ultimately mediated by lines of code and actions within the video game can be dumped into spreadsheets and databases for analysis, sports happen within a framework where the data must be collected before it can be assessed. In line with James’s early concerns about the poor state of play-by-play data in baseball, major sports leagues have invested greatly in the integration of technology to assess players and how they interact in games. Baseball pitches are tracked and the results compared with the strike zone to rate umpires. A company called Second Spectrum uses technology originally designed to track missiles to map how players move on basketball courts and soccer pitches, enabling comparative analysis about how players defend, run, and generally play the game. Catapult developed a wearable system that tracks how players stress their bodies during practice and games, aiding the ability to determine when players need a rest and when they are likely at the peak of their ability to perform. Technology has also become a means by which players, teams, and analysts can “directly engage in an active exploration to understand why and how such information may have emerged.”2 The combination of technologies to track sports makes them a bit more like a video game, where every data point is ready to be pulled into analysis. Increasing the data available to analysts creates a feedback loop, where the data can increase understanding to lead to new questions and new technological development in order to continue to refine the meta. Although there is likely to be a point of diminishing returns for both the technology and the analysis, that point will probably come when a sport is solved, which will make it far less interesting to watch and play. Baseball offers up an example of a sport that stands as a largely solved game, as analytics are widely accepted and their lessons frame strategy and play. Along the road toward solving a sport, data analysis leads to insights that change how certain teams play the game. When those teams overperform, their tactics are copied, frequently changing how the game is played and often upending decades of tradition in establishing a new “best” way to play. In baseball this shows up in defensive shifts where instead of dividing the field equally, defenders align themselves in a manner matched to where the hitter typically strikes the ball. In basketball, the three-point revolution took over as teams recognized that shots worth three points are expected to generate more points than long two-pointers and basically every shot other than those very close to the basket.3 In soccer, pressing dominates as elite teams noted that being able to win the ball high up the field makes them more likely to score and renders the opposition less likely to get a shot off. Football analytics found what Madden players had known for years, which is that going for it more often on fourth down increases offensive production (and is generally more fun). Throughout these changes, there is a back and forth as analytics debuts some new insight and established norms within the game resist. A strategy that is proven to be more effective in the long run does not take hold unless a coach or manager makes it to the long run in the first place by not getting fired. Short-run struggles, especially for those with novel approaches, can quickly leads to questions from the media and fans, potentially ending a career. For a new meta to really get established, it not only has to work, but it has to do so fairly quickly, and then as it spreads, it can become the new set of norms the next insight will have to overcome.
USER:
Give examples of how data analytics has changed the way baseball, basketball, and soccer are played.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 33 | 16 | 653 | null | 343 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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What are the key differences between macronutrients and micronutrients in terms of their functions and the amounts required by the body and how they contribute to overall health? Explain in deep details in not more than 300 words.
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What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body.
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"================ <TEXT PASSAGE> ======= What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body. https://open.maricopa.edu/nutritionessentials/chapter/essential-nutrients/#:~:text=Nutrients%20have%20one%20or%20more,breathe%2C%20grow%2C%20and%20reproduce. ================ <QUESTION> ======= What are the key differences between macronutrients and micronutrients in terms of their functions and the amounts required by the body and how they contribute to overall health? Explain in deep details in not more than 300 words. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body.
USER:
What are the key differences between macronutrients and micronutrients in terms of their functions and the amounts required by the body and how they contribute to overall health? Explain in deep details in not more than 300 words.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 38 | 1,040 | null | 178 |
Information will be provided and you are to answer the questions based only on the information provided. Do not consult the internet or use prior knowledge. Please answer concisely.
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How do the different segments compare in terms of financial results in the period discussed?
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HAMPTON, N.H., Aug. 6, 2024 /PRNewswire/ -- Today, Planet Fitness, Inc. (NYSE: PLNT) reported financial results for its second quarter ended June 30, 2024. "Since I stepped into the CEO role in June, I have become even more confident and excited about my decision to join such an iconic brand, supported by a strong foundation and team, a solid base of approximately 100 franchisees, and approximately 19.7 million members," said Colleen Keating, Chief Executive Officer. "During the quarter, we continued to demonstrate the unique strength of our asset-light, highly franchised business model by refinancing a portion of our debt and entering a $280 million accelerated share repurchase program as we strive to deliver enhanced shareholder value." Ms. Keating continued, "As we enter our next chapter, we are committed to further defining our growth ambition and capitalizing on the meaningful opportunities across the industry both in the U.S. and internationally. This includes maintaining a steadfast focus on delivering an unparalleled member experience, evolving our brand messaging and operating under the principle that when our franchisees win, we win. By doing so, I'm confident in our potential for long-term sustainable growth of stores and members, and our ability to deliver significant value for shareholders." Second Quarter Fiscal 2024 Highlights - Total revenue increased from the prior year period by 5.1% to $300.9 million. - System-wide same store sales increased 4.2%. - System-wide sales increased to $1.2 billion from $1.1 billion in the prior year period. - Net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. - Net income increased $5.1 million to $49.3 million, compared to $44.2 million in the prior year period. - Adjusted net income(1) increased $4.5 million to $62.2 million, or $0.71 per diluted share(1), compared to $57.7 million, or $0.65 per diluted share, in the prior year period. - Adjusted EBITDA(1) increased $8.6 million to $127.5 million from $118.9 million in the prior year period. - 18 new Planet Fitness stores were opened system-wide during the period, which included 17 franchisee-owned and 1 corporate-owned stores, bringing system-wide total stores to 2,617 as of June 30, 2024. - Cash and marketable securities of $447.7 million, which includes cash and cash equivalents of $247.0 million, restricted cash of $47.8 million and marketable securities of $152.9 million as of June 30, 2024. (1) Adjusted net income, Adjusted EBITDA and Adjusted net income per share, diluted are non-GAAP measures. For reconciliations of Adjusted EBITDA and Adjusted net income to U.S. GAAP ("GAAP") net income and a computation of Adjusted net income per share, diluted, see "Non-GAAP Financial Measures" accompanying this press release. Operating Results for the Second Quarter Ended June 30, 2024 For the second quarter of 2024, total revenue increased $14.5 million or 5.1% to $300.9 million from $286.5 million in the prior year period, including system-wide same store sales growth of 4.2%. By segment: - Franchise segment revenue increased $8.9 million or 9.1% to $107.8 million from $98.8 million in the prior year period. Of the increase, $6.3 million was due to higher royalty revenue, of which $3.1 million was attributable to a franchise same store sales increase of 4.3%, $1.8 million was attributable to new stores opened since April 1, 2023 and $1.3 million was from higher royalties on annual fees. Franchise segment revenue also includes $2.1 million of higher National Advertising Fund ("NAF") revenue; - Corporate-owned stores segment revenue increased $11.7 million or 10.3% to $125.5 million from $113.8 million in the prior year period. Of the increase, $6.6 million was attributable to corporate-owned stores included in the same store sales base, of which $1.9 million was attributable to a same store sales increase of 4.0%, $1.9 million was attributable to higher annual fee revenue and $2.9 million was attributable to other fees. Additionally, $5.1 million was from new stores opened and acquired since April 1, 2023; and - Equipment segment revenue decreased $6.2 million or 8.4% to $67.7 million from $73.9 million in the prior year period. Of the decrease, $4.7 million was due to lower revenue from equipment sales to new franchisee-owned stores and $1.5 million was due to lower revenue from equipment sales to existing franchisee-owned stores. In the second quarter of 2024, we had equipment sales to 18 new franchisee-owned stores compared to 26 in the prior year period. For the second quarter of 2024, net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. Net income was $49.3 million in the second quarter of 2024 compared to $44.2 million in the prior year period. Adjusted net income increased 7.8% to $62.2 million, or $0.71 per diluted share, from $57.7 million, or $0.65 per diluted share, in the prior year period. Adjusted net income has been adjusted to reflect a normalized income tax rate of 25.8% and 25.9% for the second quarter of 2024 and 2023, respectively, and excludes certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see "Non-GAAP Financial Measures"). Adjusted EBITDA, which is defined as net income before interest, taxes, depreciation and amortization, adjusted for the impact of certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see "Non-GAAP Financial Measures"), increased 7.2% to $127.5 million from $118.9 million in the prior year period.Segment EBITDA represents our Total Segment EBITDA broken down by the Company's reportable segments. Total Segment EBITDA is equal to EBITDA, which is defined as net income before interest, taxes, depreciation and amortization (see "Non-GAAP Financial Measures"). - Franchise segment EBITDA increased $11.3 million or 17.1% to $77.4 million. The increase is primarily the result of a $8.9 million increase in franchise segment revenue as described above, as well as a $3.1 million legal reserve that negatively impacted the second quarter of 2023 and $1.5 million of lower selling, general and administrative expense in the second quarter of 2024, partially offset by $2.2 million of higher NAF expense; - Corporate-owned stores segment EBITDA increased $0.6 million or 1.2% to $49.3 million. The increase was primarily attributable to $0.8 million from the corporate-owned same store sales increase of 4.0%. - Equipment segment EBITDA increased $1.4 million or 8.4% to $18.6 million. The increase was primarily driven by higher margin equipment sales related to an updated equipment mix as a result of the adoption of the new growth model.
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Information will be provided and you are to answer the questions based only on the information provided. Do not consult the internet or use prior knowledge. Please answer concisely. HAMPTON, N.H., Aug. 6, 2024 /PRNewswire/ -- Today, Planet Fitness, Inc. (NYSE: PLNT) reported financial results for its second quarter ended June 30, 2024. "Since I stepped into the CEO role in June, I have become even more confident and excited about my decision to join such an iconic brand, supported by a strong foundation and team, a solid base of approximately 100 franchisees, and approximately 19.7 million members," said Colleen Keating, Chief Executive Officer. "During the quarter, we continued to demonstrate the unique strength of our asset-light, highly franchised business model by refinancing a portion of our debt and entering a $280 million accelerated share repurchase program as we strive to deliver enhanced shareholder value." Ms. Keating continued, "As we enter our next chapter, we are committed to further defining our growth ambition and capitalizing on the meaningful opportunities across the industry both in the U.S. and internationally. This includes maintaining a steadfast focus on delivering an unparalleled member experience, evolving our brand messaging and operating under the principle that when our franchisees win, we win. By doing so, I'm confident in our potential for long-term sustainable growth of stores and members, and our ability to deliver significant value for shareholders." Second Quarter Fiscal 2024 Highlights - Total revenue increased from the prior year period by 5.1% to $300.9 million. - System-wide same store sales increased 4.2%. - System-wide sales increased to $1.2 billion from $1.1 billion in the prior year period. - Net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. - Net income increased $5.1 million to $49.3 million, compared to $44.2 million in the prior year period. - Adjusted net income(1) increased $4.5 million to $62.2 million, or $0.71 per diluted share(1), compared to $57.7 million, or $0.65 per diluted share, in the prior year period. - Adjusted EBITDA(1) increased $8.6 million to $127.5 million from $118.9 million in the prior year period. - 18 new Planet Fitness stores were opened system-wide during the period, which included 17 franchisee-owned and 1 corporate-owned stores, bringing system-wide total stores to 2,617 as of June 30, 2024. - Cash and marketable securities of $447.7 million, which includes cash and cash equivalents of $247.0 million, restricted cash of $47.8 million and marketable securities of $152.9 million as of June 30, 2024. (1) Adjusted net income, Adjusted EBITDA and Adjusted net income per share, diluted are non-GAAP measures. For reconciliations of Adjusted EBITDA and Adjusted net income to U.S. GAAP ("GAAP") net income and a computation of Adjusted net income per share, diluted, see "Non-GAAP Financial Measures" accompanying this press release. Operating Results for the Second Quarter Ended June 30, 2024 For the second quarter of 2024, total revenue increased $14.5 million or 5.1% to $300.9 million from $286.5 million in the prior year period, including system-wide same store sales growth of 4.2%. By segment: - Franchise segment revenue increased $8.9 million or 9.1% to $107.8 million from $98.8 million in the prior year period. Of the increase, $6.3 million was due to higher royalty revenue, of which $3.1 million was attributable to a franchise same store sales increase of 4.3%, $1.8 million was attributable to new stores opened since April 1, 2023 and $1.3 million was from higher royalties on annual fees. Franchise segment revenue also includes $2.1 million of higher National Advertising Fund ("NAF") revenue; - Corporate-owned stores segment revenue increased $11.7 million or 10.3% to $125.5 million from $113.8 million in the prior year period. Of the increase, $6.6 million was attributable to corporate-owned stores included in the same store sales base, of which $1.9 million was attributable to a same store sales increase of 4.0%, $1.9 million was attributable to higher annual fee revenue and $2.9 million was attributable to other fees. Additionally, $5.1 million was from new stores opened and acquired since April 1, 2023; and - Equipment segment revenue decreased $6.2 million or 8.4% to $67.7 million from $73.9 million in the prior year period. Of the decrease, $4.7 million was due to lower revenue from equipment sales to new franchisee-owned stores and $1.5 million was due to lower revenue from equipment sales to existing franchisee-owned stores. In the second quarter of 2024, we had equipment sales to 18 new franchisee-owned stores compared to 26 in the prior year period. For the second quarter of 2024, net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. Net income was $49.3 million in the second quarter of 2024 compared to $44.2 million in the prior year period. Adjusted net income increased 7.8% to $62.2 million, or $0.71 per diluted share, from $57.7 million, or $0.65 per diluted share, in the prior year period. Adjusted net income has been adjusted to reflect a normalized income tax rate of 25.8% and 25.9% for the second quarter of 2024 and 2023, respectively, and excludes certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see "Non-GAAP Financial Measures"). Adjusted EBITDA, which is defined as net income before interest, taxes, depreciation and amortization, adjusted for the impact of certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see "Non-GAAP Financial Measures"), increased 7.2% to $127.5 million from $118.9 million in the prior year period.Segment EBITDA represents our Total Segment EBITDA broken down by the Company's reportable segments. Total Segment EBITDA is equal to EBITDA, which is defined as net income before interest, taxes, depreciation and amortization (see "Non-GAAP Financial Measures"). - Franchise segment EBITDA increased $11.3 million or 17.1% to $77.4 million. The increase is primarily the result of a $8.9 million increase in franchise segment revenue as described above, as well as a $3.1 million legal reserve that negatively impacted the second quarter of 2023 and $1.5 million of lower selling, general and administrative expense in the second quarter of 2024, partially offset by $2.2 million of higher NAF expense; - Corporate-owned stores segment EBITDA increased $0.6 million or 1.2% to $49.3 million. The increase was primarily attributable to $0.8 million from the corporate-owned same store sales increase of 4.0%. - Equipment segment EBITDA increased $1.4 million or 8.4% to $18.6 million. The increase was primarily driven by higher margin equipment sales related to an updated equipment mix as a result of the adoption of the new growth model. How do the different segments compare in terms of financial results in the period discussed?
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Information will be provided and you are to answer the questions based only on the information provided. Do not consult the internet or use prior knowledge. Please answer concisely.
EVIDENCE:
HAMPTON, N.H., Aug. 6, 2024 /PRNewswire/ -- Today, Planet Fitness, Inc. (NYSE: PLNT) reported financial results for its second quarter ended June 30, 2024. "Since I stepped into the CEO role in June, I have become even more confident and excited about my decision to join such an iconic brand, supported by a strong foundation and team, a solid base of approximately 100 franchisees, and approximately 19.7 million members," said Colleen Keating, Chief Executive Officer. "During the quarter, we continued to demonstrate the unique strength of our asset-light, highly franchised business model by refinancing a portion of our debt and entering a $280 million accelerated share repurchase program as we strive to deliver enhanced shareholder value." Ms. Keating continued, "As we enter our next chapter, we are committed to further defining our growth ambition and capitalizing on the meaningful opportunities across the industry both in the U.S. and internationally. This includes maintaining a steadfast focus on delivering an unparalleled member experience, evolving our brand messaging and operating under the principle that when our franchisees win, we win. By doing so, I'm confident in our potential for long-term sustainable growth of stores and members, and our ability to deliver significant value for shareholders." Second Quarter Fiscal 2024 Highlights - Total revenue increased from the prior year period by 5.1% to $300.9 million. - System-wide same store sales increased 4.2%. - System-wide sales increased to $1.2 billion from $1.1 billion in the prior year period. - Net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. - Net income increased $5.1 million to $49.3 million, compared to $44.2 million in the prior year period. - Adjusted net income(1) increased $4.5 million to $62.2 million, or $0.71 per diluted share(1), compared to $57.7 million, or $0.65 per diluted share, in the prior year period. - Adjusted EBITDA(1) increased $8.6 million to $127.5 million from $118.9 million in the prior year period. - 18 new Planet Fitness stores were opened system-wide during the period, which included 17 franchisee-owned and 1 corporate-owned stores, bringing system-wide total stores to 2,617 as of June 30, 2024. - Cash and marketable securities of $447.7 million, which includes cash and cash equivalents of $247.0 million, restricted cash of $47.8 million and marketable securities of $152.9 million as of June 30, 2024. (1) Adjusted net income, Adjusted EBITDA and Adjusted net income per share, diluted are non-GAAP measures. For reconciliations of Adjusted EBITDA and Adjusted net income to U.S. GAAP ("GAAP") net income and a computation of Adjusted net income per share, diluted, see "Non-GAAP Financial Measures" accompanying this press release. Operating Results for the Second Quarter Ended June 30, 2024 For the second quarter of 2024, total revenue increased $14.5 million or 5.1% to $300.9 million from $286.5 million in the prior year period, including system-wide same store sales growth of 4.2%. By segment: - Franchise segment revenue increased $8.9 million or 9.1% to $107.8 million from $98.8 million in the prior year period. Of the increase, $6.3 million was due to higher royalty revenue, of which $3.1 million was attributable to a franchise same store sales increase of 4.3%, $1.8 million was attributable to new stores opened since April 1, 2023 and $1.3 million was from higher royalties on annual fees. Franchise segment revenue also includes $2.1 million of higher National Advertising Fund ("NAF") revenue; - Corporate-owned stores segment revenue increased $11.7 million or 10.3% to $125.5 million from $113.8 million in the prior year period. Of the increase, $6.6 million was attributable to corporate-owned stores included in the same store sales base, of which $1.9 million was attributable to a same store sales increase of 4.0%, $1.9 million was attributable to higher annual fee revenue and $2.9 million was attributable to other fees. Additionally, $5.1 million was from new stores opened and acquired since April 1, 2023; and - Equipment segment revenue decreased $6.2 million or 8.4% to $67.7 million from $73.9 million in the prior year period. Of the decrease, $4.7 million was due to lower revenue from equipment sales to new franchisee-owned stores and $1.5 million was due to lower revenue from equipment sales to existing franchisee-owned stores. In the second quarter of 2024, we had equipment sales to 18 new franchisee-owned stores compared to 26 in the prior year period. For the second quarter of 2024, net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. Net income was $49.3 million in the second quarter of 2024 compared to $44.2 million in the prior year period. Adjusted net income increased 7.8% to $62.2 million, or $0.71 per diluted share, from $57.7 million, or $0.65 per diluted share, in the prior year period. Adjusted net income has been adjusted to reflect a normalized income tax rate of 25.8% and 25.9% for the second quarter of 2024 and 2023, respectively, and excludes certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see "Non-GAAP Financial Measures"). Adjusted EBITDA, which is defined as net income before interest, taxes, depreciation and amortization, adjusted for the impact of certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see "Non-GAAP Financial Measures"), increased 7.2% to $127.5 million from $118.9 million in the prior year period.Segment EBITDA represents our Total Segment EBITDA broken down by the Company's reportable segments. Total Segment EBITDA is equal to EBITDA, which is defined as net income before interest, taxes, depreciation and amortization (see "Non-GAAP Financial Measures"). - Franchise segment EBITDA increased $11.3 million or 17.1% to $77.4 million. The increase is primarily the result of a $8.9 million increase in franchise segment revenue as described above, as well as a $3.1 million legal reserve that negatively impacted the second quarter of 2023 and $1.5 million of lower selling, general and administrative expense in the second quarter of 2024, partially offset by $2.2 million of higher NAF expense; - Corporate-owned stores segment EBITDA increased $0.6 million or 1.2% to $49.3 million. The increase was primarily attributable to $0.8 million from the corporate-owned same store sales increase of 4.0%. - Equipment segment EBITDA increased $1.4 million or 8.4% to $18.6 million. The increase was primarily driven by higher margin equipment sales related to an updated equipment mix as a result of the adoption of the new growth model.
USER:
How do the different segments compare in terms of financial results in the period discussed?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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Create a short paragraph response to the question using clear, precise vocabulary. This should only rely on information contained in the text.
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What is Actor Network Theory, and how does it help us understand the failure of Google Glass?
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Analysis of the Google Glass Failure and Why Things May Be Different Now A Research Paper submitted to the Department of Engineering and Society Presented to the Faculty of the School of Engineering and Applied Science University of Virginia • Charlottesville, Virginia In Partial Fulfillment of the Requirements for the Degree Bachelor of Science, School of Engineering Tyler Labiak Spring, 2021 On my honor as a University Student, I have neither given nor received unauthorized aid on this assignment as defined by the Honor Guidelines for Thesis-Related Assignments Signature __________________________________________ Date __________ Tyler Labiak Approved __________________________________________ Date __________ Sharon Tsai-hsuan Ku, Department of Engineering and Society 5/8/2021 Introduction As technology continues to advance at breakneck speeds into the unknown, humans are increasingly defined by their creations. Inventions alter history, mediate human-perception, deepen (or obscure) knowledge, and modify socialization. Also, throughout history, technology has come to exist through human political, economic, cultural, and social factors (Law, 1987). To best understand and guide the development of technology, and consequently humanity, much work has been done researching the social means by which technology comes to exist and, inversely, the effects of technology on society. Of course, the human drivers behind technology’s development and adoption are not static. Social constructs like privacy, data ethics, safety standards, and social norms change over time as society changes and, consequently, as technology changes. Therefore, technology must be evaluated in the context of its creation and usage. This paper hopes to highlight this temporal element in analyzing technology in the context of a dynamic society. Google Glass is a device that society rejected not as a bad piece of technology, but rather as a socio-technical artifact. The reality of Google Glass is that its engineers did not consciously design the human-technological interaction that they were creating and failed to see how the product would affect social interactions and perceptions of privacy. As a result, there was backlash against the product leading to its failure. However, today’s attitudes surrounding technology and privacy have further laxed; technological advances have shaped a sociotechnical context where Glass may succeed today or in the future. This paper utilizes Actor Network Theory to demonstrate how Google failed to coalesce a human, non-human network in developing Glass, expanding on prior work to show how the conditions surrounding Glass have evolved with time. To achieve the above conclusions, this paper analyzes media and primary sources from the time of release of Glass, academic and retrospective journalism pertaining to the failure of Glass, interviews with non-experts and experts about this technology, and current Glass enthusiasts via the Google Glass subreddit. Literature Review In April 2013 Google began accepting applications for the public to purchase a pair of smart glasses that Google believed was a major step in the direction of their dream “that computers and the Internet will be accessible anywhere and we can ask them to do things without lifting a finger” (Miller, 2013). This was the Explorer version of Google Glass, outfitted with a small screen and camera, and connected to a smartphone and the internet over Bluetooth or Wifi (Miller, 2013). Essentially a beta test for developers, the purpose of the “Explorer program [was] to find out how people want to (and will) use Glass” (Topolsky, 2013). The expectations around Google Glass were massive, with Business Insider (2013) expecting a $10.5 billion dollar opportunity for Google as unit sales would increase and the price would decrease until Glass was the next “ubiquitous” technology. However, the glasses failed spectacularly with media citing that Google overpromised and underdelivered (Yoon, 2018). Of course, this does not tell the entire story. Many people will not know that Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing, healthcare, and logistics businesses for a workplace hands-off augmented reality computer (“Glass”, 2021). Similarly, Microsoft Hololens allows a headset based industrial mixed reality solution (“Hololens”, 2021). So, if these technologies have proven themselves in a commercial space, what went wrong in the public setting? During Glass’s Explorer phase there was a slew of privacy concerns associated with the fact that wearing Glass meant wielding a camera at all times. To some, Google Glass was a rare example of people pushing back against big tech regarding privacy. People were kicked out of bars because of the recording aspect, the NYT ran a front-page story about privacy concerns, activists set up groups to push back against the product, and policies were implemented that forbid people from taking pictures without consent (Eveleth, 2018). Kudina and Verbeek (2019) explored how Glass mediated the value of privacy by analyzing YouTube comments from the time of release. However, there is little consideration given to the temporal aspects of sociotechnical interaction. It is essential that Glass is examined, not only in the context of its release, but also with respect to changing norms, human perceptions, and technologies. Without asking these questions, we remain unprepared to answer whether a similar technology could succeed today or in the future. “Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy” by Olya Kudina and Paul-Peter Verbeek (2019) examines online discussions about Google Glass, particularly comments on a YouTube video produced by Google, in order to understand “how people articulate new meanings of the value of privacy.” This case study serves as a demonstration of Verbeek’s own Theory of Technological Mediation, which allows a focus on “the dynamics of the interaction between technologies and human values” as a way of addressing the Collingridge Dilemma, which applied here says that when a technology is young it is unknown how it will affect systems, and that by the time the morality surrounding technology is clear, it is difficult to develop the already widespread technology. According to mediation theory, engineers design not just products, but they design human-technological interactions in the world. Technology acts as a mediator, shaping personal experiences and objects while humans and tech are not separate, but affect each other in their relations. Rather than speculating about the future, “it studies the dynamics of technomoral change itself.” While Verbeek’s paper serves as a launch point for human perception around the time of Glass’s release, and is drawn upon greatly in the below analysis, the data set is of course not representative of today’s cultural technological landscape. Therefore, this paper hopes to extend on this work in describing not just Glass’s initial rejection given its social context at the time, but also inspect perceptions of the technology today. Conceptual Frameworks and Research Methods This paper draws mainly on Darryl Cressman’s (2009) overview of Actor Network Theory and the following definitions are derived from his work unless otherwise cited. In Actor Network Theory everything, both human and non-human can be viewed as both an actor and a network. These actor networks are therefore sociotechnical in nature, and they are sometimes referred to as heterogenous networks. A network is defined by the associations it describes; therefore, power of the network and association are intertwined. Additionally, power and meaning are not inherent to any single actor within a network, rather they are associative, relational and contextual. When that actor becomes part of another network its associations change, and as a result its power or meaning changes. Meaning is ascribed to actors with a network contextually rather innately (Cressman, 2009). Engineers in ANT practice heterogeneous engineering, assembling actor networks that are both human and technical in nature. To understand how the world works, practitioners of ANT must understand how economic, political, social, and technological understanding interact with each other. In contrast to other STS theories, ANT is symmetrical in the influence of both the technical and nontechnical (Cressman, 2009). Technological innovation comes from the process in ANT known as translation. This is the process by which both the social and technical actors are recruited into a network. This does not happen at once, rather actors are recruited in a gradient as the network gradually becomes more robust. In understanding the world through ANT, there is an emphasis on connections rather than the individual, and these connections are not all equal (Cressman, 2009). The conclusion of Actor Network Theory is that for a network to succeed, an engineer must consider all actors human, nonhuman, technical, political, economic, social, etc. Engineers are therefore world builders (Law, 1987), and recruiting actors to make a socially robust network is the triumph of a network. Neglecting the social aspects, or encountering rogue actors, leads to a failed network. It will be shown that this is exactly how Google failed as a network builder; thus, the tools of ANT were chosen to explore this dynamic. In addition to the academic papers cited and journalistic releases analyzed below, two means of research were also applied. In order to gain a sense of how potential users today perceive Google Glass or similar technology, interviews were conducted on a group of nonexperts and peers, as well as one industry expert, and enthusiasts of the technology were gauged via posts on the Google Glass enthusiast subreddit “r/googleglass”. The purpose of the interviews was not to poll a representative set of the opinions surrounding Glass, rather to guide research and find some interesting perspectives surrounding the technology and privacy today. Subjects were aged 22 to 57 and varied in occupation, education and sex. All interviewees could be broadly incorporated in a target audience for Google, as all of them consume smart technology already. The interviewees were asked what they knew about Google Glass, then asked a set of questions about smart technology, ubiquitous recording, privacy, and legality, and finally were asked to give their opinion on the viability of a product like Glass coming back in the future. Interviewees’ knowledge regarding Glass ranged from having never heard of the product, to familiarity, to an industry insider who markets technology products for Apple and has worked with former Glass developers. It is important to emphasize that these interviewees were not randomly selected and do not number great enough to act as a focus group of sorts for the product, but they guided research and topic discovery as well as offer a scope of perspectives in this area. The second group considered are users of the subreddit “r/googleglass.” This is an enthusiast forum dedicated to the technology. The studied materials consisted of the forum “Top, This Year” as of March 2021, meaning that these posts were the most “upvoted,” or received the most positive interactions on that forum for the year. These posts were chosen because they represent the most popular current opinions and perceptions from the enthusiast community. Analysis In the case of Glass, Google serves as the network builder in assembling Glass, not just the technology but also the human technical interactions. In ANT, technology and society are dual, in that they exert influence on and shape each other. This is also articulated by Verbeek through his Technological Mediation framework, claiming that Glass mediates privacy itself. In the below section, media from the time of Glass’s release will be analyzed to see how the associations of Glass with these rogue actors lead to the destabilization of the network all together. Moving chronologically, the first article analyzed is from February 2013, nearly two months prior to the launch of the explorer version of Glass. A writer from The Verge met with Google Glass lead designers for an early test of the product. The author of the article is, as expected of a tech magazine writer, very optimistic about Google Glass noting the “tremendous value and potential.” He praises the design, appearance, functionality and wearability of the device but also posts an early warning sign about the fate of Glass: “At one point during my time with Glass, we all went out to navigate to a nearby Starbucks — the camera crew I’d brought with me came along. As soon as we got inside however, the employees at Starbucks asked us to stop filming. Sure, no problem. But I kept the Glass’ video recorder going, all the way through my order and getting my coffee. Yes, you can see a light in the prism when the device is recording, but I got the impression that most people had no idea what they were looking at. The cashier seemed to be on the verge of asking me what I was wearing on my face, but the question never came. He certainly never asked me to stop filming.” (Topolsky, 2013) The author is keenly aware of the issues looming for Google Glass, saying in his own words, “The privacy issue is going to be a big hurdle for Google with Glass”. When he brought this up to the Glass designers he met with (product director Steve Lee and lead industrial designer Isabelle Olsson). Their belief was that the explorer program was their way of developing an etiquette surrounding Glass. The use and misuse of the program would be monitored by Google and feedback would move the product forward. The author then remarks “that’s not going to answer questions about what’s right and wrong to do with a camera that doesn’t need to be held up to take a photo, and often won’t even be noticed by its owner’s subjects. Will people get comfortable with that? Are they supposed to?” (Topolsky, 2013) From an ANT perspective, privacy is not just a concept but rather a socio-technical actor existing in their network. It is equally important for Google to consider how Glass allows people to record the world and affect others notions of privacy. However, there is almost an apathy here in the Explorer program. Google acknowledges that through the Explorer program they can develop an etiquette around Glass, while recruiting people to their network, but without taking an active role in designing a project that is socially harmonious, their network is unstable. As the author stated, their tech fails to answer the questions about what people will do with a camera and if that’s okay. Google’s technological optimism, or potentially their naivete, comes through perhaps strongest in an influential New York Times article from the time of release of Google Glass. This article, titled “Google Glass Picks Up Early Signal: Keep Out” details the negative responses that Google Glass was getting form various places around the country, and contrasts it with Google’s reputation for being cavalier around privacy. The article quotes Google’s former CEO Eric Schmidt in 2009 saying, “If you have something that you don’t want anyone to know, maybe you shouldn’t be doing it in the first place” (Streitfield, 2013). It is clear that this policy permeates through to their implementation of Glass, which potentially immortalizes the public realm through ubiquitous recording, thus making potentially everything known to everyone. A contributing law expert is quoted as saying “We are all now going to be both the paparazzi and the paparazzi’s target” (Streitfield, 2013). Furthermore, the article reports that app developers made photography with glass as discrete as simply winking in one application (Streitfield, 2013). To many this makes Glass even more intrusive, and although it is unclear if Google would have allowed a feature like this in their final release, the Explorer program was essential for gradually recruiting public acceptance into the Glass network. Of course, they failed to do so. The New York Times article also speaks on a Seattle bar that banned Glass. The owner of the bar reported to Geekwire that Glass disrupted the private and seedy culture of his bar: “People want to go there and be not known … and definitely don’t want to be secretly filmed or videotaped and immediately put on the Internet” (Bishop, 2013). He also notes that “tech geeks” from Amazon frequent the bar, and he doesn’t want them using Glass inside. This “tech geek backlash” is another overarching theme regarding these reactionary articles. As one writer put it, “Google’s core mistake was allowing geeky developers to become the face of Glass” (Constine, 2017). This made recruitment of a more privacy conscious group difficult for Google, since all of a sudden there was an Us vs the “Glassholes” dynamic. The Five Point owners, the geeky big tech employees, and its various bargoers represent a key factor that must be considered when assembling a socially robust network. The associations surrounding actors in a network are entirely variable and context dependent. Where Google employees may look favorably on how Glass impacts social dynamics, the same is not true of all society. The heterogenous engineer of ANT does engineering outside the lab creating a network that is socially robust, while Google perhaps looks only inward on its own norms. Kudina and Verbeek’s (2009) paper using Technological Mediation digs deeper into how Google approached human behavior and Glass. Google called on the best judgement of its users and published a list of dos and don’ts surrounding Glass and sat back to observe. The author turns to gauging Glass’s mediation of privacy and social interaction via YouTube comments on this list of dos and don’ts during the explorer phase of Glass. One conclusion is that “Glass appears as a mediating boundary object between what commenters consider private even in the most public places and what is violated when the device is introduced,” and to online commenters “the privacy of forgetting [is] at stake with Glass.” As a designer, under Technological Mediation, Google creates the mediations, and perhaps for Glass to succeed they needed to be aware of what human interactions and perceptions were actually being designed. This wraps into actor network theory nicely, since under ANT designers are responsible for recruiting the actors that are both human and nonhuman to a sociotechnical network. The designers are the builders of society, and Google failed in creating a network that is stable both socially and technically. A few years later, SnapChat created the spectacles which were smart glasses that allowed users to record footage and post to snapchat. However, without addressing the social issues, the same fate occurred and this network too failed as reported by TechCrunch: “Google Glass tainted the market with its ‘not sure if you’re recording me’ design. Even though Snap put more obvious recording signal lights on Spectacles, people would still question you about whether they were on camera. That not only made people uncomfortable being around Spectacles, but made you feel like a bit of a creep just wearing them” (Constine, 2017). This is not to say that there is no hope for augmented reality. Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing and healthcare businesses. In this space the context is completely different, and the expectation of privacy spoken about by Verbeek does not exist in the same caliber. Privacy, under ANT, can be considered an actor-network, since it is defined by humans and technological relations. Therefore, it is also subject to the contextuality present in ANT and takes on a different meaning in the workplace. There is already perhaps an expectation of being observed at work, at least to some extent, and especially in manufacturing settings. Computer surveillance software, security cameras, and sensors in manufacturing monitor people’s actions already in a way that would be unacceptable in the private space. From an ANT perspective this clearly represents the idea of variable meanings of actors in different networks. As a result, Google is able to recruit companies and people to their enterprise network, where associations with privacy hold different meanings. Strictly speaking, the technology for these products to exist was never the problem; rather, Glass, people, and privacy take on different meanings in a business setting and the public space. While Glass may have been initially deemed unacceptable by society, human perceptions are subject to change as a result of the technical landscape that permeates life around us. Much has changed since 2013 when Glass was released. The privacy paradox states that individuals may desire privacy, but are willing to exchange it for the benefits of technology (Eveleth, 2018). What was once considered off limits could potentially now be acceptable, as technology has shaped our views of what is wrong and right. Evidence of this lies in the still active Reddit group dedicated to Google Glass. Users here are still developing software for Glass including the top poster writing about hacking a version of Android onto Glass. There are many posts about buying and selling the technology as well as discussing alternative smart glasses. The discussions in the community consist of instructions on how to load firmware updates onto Glass as well as loading custom apps such as Netflix which is popular among users on the subreddit. Additionally, there are troubleshooting posts, guides, blogs and external repositories of apps discussed, linked and posted on the forum. In stark contrast to the YouTube comments analyzed by Verbeek, these users have embraced Glass and taken on the role of designers in an enthusiast ecosystem. The general consensus here is also a longing or even optimism about new Google Glass products, and that the original Glass was “ahead of its time”. In conducted interviews, while the subjects varied in terms of their individual privacy beliefs, no subject so far has said that Glass or a similar device should be banned. More importantly, there was consensus that a product like Glass could or will exist in the future. One expert who Apple contracts for marketing, said “if Apple released their version of Google Glass in two years it will be everywhere.” Others, especially young people, saw no problem whatsoever with the technology, even after having experts’ concerns explained. The justification was that privacy is already so compromised by technology and governments. Nearly all interviewees believed that if a product like this came out in the future, and was a commercial success they would see no problem at all. Like the reddit users, these interviewees are a far cry from the mainstream privacy worry in 2013. In observing both Reddit posters and interviewees, one cannot determine for certain whether Google Glass could reclaim success today. However, these examples show that the meaning of actor networks can be derived from context that is time dependent as well. Glass is not innately moral or immoral. Rather, Society’s expectations for privacy, and their morals surrounding the subject, change with time and the influence of technology. In Actor Network Theory this is the symmetry of humans affecting technology and technology impacting humans. While Google failed to realize how these human factors played into their network originally, perhaps today or in the near future privacy, as its own actor network, will evolve in such a way that Glass can exist as a socially robust network. Conclusion Google Glass is an actor-network that dissolved, not as a result of its technology or any specific actor, but rather because of the associations and context these human and nonhuman actors take on in translating the network. In a public space, from the beginning Glass represented a form of ubiquitous and secret recording, because there was the assumption that anybody at any time could be caught on the glasses’ camera. Technology mediates human perception, and in this case, Glass lends new meaning to what is considered private. In an Actor Network framework, this is a demonstration of the symmetry of human and non-human artifacts influencing each other, and without these considerations the network was bound to fail. Rather than design a product that was both social and technical, Google maintained its cavalier approach to privacy, not considering how people may have reacted to digitalizing the world’s eyesight. Google employees and glass users at the time were optimistic about the future of the product, believing that the product would come to be socially acceptable. This captures the idea of association and context ascribing meaning in ANT. While Glass may have been acceptable in Silicon Valley, it did not get the same reception in the main stream. Similarly, while Google could not release this product to the public it has faced success in manufacturing, healthcare, and logistic settings as have other augmented reality headsets. Again, here privacy and people’s expectations take on a new meaning in the Google Glass Enterprise actor-network. Much has changed since the release of Google Glass. It has become an expectation in these times that users trade free services for their own personal data. We have all had our ideas of privacy mediated by technology in this way. It may be possible then, that in the current year or in the future a product like Glass will resurface, as it has done in the manufacturing space. Some Reddit users, for example, have put Google Glass to use in their own lives, modifying and distributing updated software for the glasses. The consensus on these forums is that Glass was ahead of its time, and there is consensus among interviewed potential users that a product like this could succeed. From an ANT perspective, again it is clear that the context of associations within the network matter, rather than the individual parts, and these are all dynamic with respect to time. If a product like Glass was to reach mainstream success, it would not be strictly the technology, but rather the recruitment of the technology, the human users, and the social norms of today or the future that yield a stable network. While Google Glass as a high-profile product failure has been written about extensively, there is little in the vein of an STS perspective, and that work focuses on the lens of society at Glasses release date. The efforts of this paper are to provide an example of how the tools of ANT can be used to not only analyze the building (and failure) of a technology, but also emphasize how associations change with context, specifically time. These considerations are essential for understanding not just the deployment of future technologies, but also the transient nature of social norms. References Bishop, T. (2013, March 8). No Google Glasses allowed, declares Seattle dive bar. GeekWire. https://www.geekwire.com/2013/google-glasses-allowed-declares-seattle-dive-bar/ Constine, J. (2017, October 28). Why Snapchat Spectacles failed. TechCrunch. https://social.techcrunch.com/2017/10/28/why-snapchat-spectacles-failed/ Cressman, D. (2009). A Brief Overview of Actor-Network Theory: Punctualization, Heterogeneous Engineering & Translation. https://summit.sfu.ca/item/13593 Eveleth, R (2018). Google Glass Wasn’t a Failure. It Raised Crucial Concerns. WIRED. (n.d.). Retrieved November 1, 2020, from https://www.wired.com/story/google-glass-reasonableexpectation-of-privacy/ Glass. (n.d.). Glass. Retrieved November 2, 2020, from https://www.google.com/glass/start/ Insider, B. (n.d.). BI INTELLIGENCE FORECAST: Google Glass Will Be An $11 Billion Market By 2018. Business Insider. Retrieved November 1, 2020, from https://www.businessinsider.com/google-glass-11-billion-market-by-2018-2013-5 Kudina, O., & Verbeek, P.-P. (2019). Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy. Science, Technology, & Human Values, 44(2), 291–314. https://doi.org/10.1177/0162243918793711 Law, J. (1987). On the Social Explanation of Technical Change: The Case of the Portuguese Maritime Expansion. Technology and Culture, 28(2), 227–252. https://doi.org/10.2307/3105566 Microsoft HoloLens | Mixed Reality Technology for Business. (n.d.). Retrieved March 27, 2021, from https://www.microsoft.com/en-us/hololens Miller, C. C. (2013, February 21). Google Searches for Style. The New York Times. https://www.nytimes.com/2013/02/21/technology/google-looks-to-make-its-computer-glassesstylish.html Streitfeld, D. (2013, May 7). Google Glass Picks Up Early Signal: Keep Out. The New York Times. https://www.nytimes.com/2013/05/07/technology/personaltech/google-glass-picks-up-earlysignal-keep-out.html Topolsky, J. (2013, February 22). I used Google Glass: The future, but with monthly updates. The Verge. https://www.theverge.com/2013/2/22/4013406/i-used-google-glass-its-the-future-withmonthly-updates
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Create a short paragraph response to the question using clear, precise vocabulary. This should only rely on information contained in the text. What is Actor Network Theory, and how does it help us understand the failure of Google Glass? Analysis of the Google Glass Failure and Why Things May Be Different Now A Research Paper submitted to the Department of Engineering and Society Presented to the Faculty of the School of Engineering and Applied Science University of Virginia • Charlottesville, Virginia In Partial Fulfillment of the Requirements for the Degree Bachelor of Science, School of Engineering Tyler Labiak Spring, 2021 On my honor as a University Student, I have neither given nor received unauthorized aid on this assignment as defined by the Honor Guidelines for Thesis-Related Assignments Signature __________________________________________ Date __________ Tyler Labiak Approved __________________________________________ Date __________ Sharon Tsai-hsuan Ku, Department of Engineering and Society 5/8/2021 Introduction As technology continues to advance at breakneck speeds into the unknown, humans are increasingly defined by their creations. Inventions alter history, mediate human-perception, deepen (or obscure) knowledge, and modify socialization. Also, throughout history, technology has come to exist through human political, economic, cultural, and social factors (Law, 1987). To best understand and guide the development of technology, and consequently humanity, much work has been done researching the social means by which technology comes to exist and, inversely, the effects of technology on society. Of course, the human drivers behind technology’s development and adoption are not static. Social constructs like privacy, data ethics, safety standards, and social norms change over time as society changes and, consequently, as technology changes. Therefore, technology must be evaluated in the context of its creation and usage. This paper hopes to highlight this temporal element in analyzing technology in the context of a dynamic society. Google Glass is a device that society rejected not as a bad piece of technology, but rather as a socio-technical artifact. The reality of Google Glass is that its engineers did not consciously design the human-technological interaction that they were creating and failed to see how the product would affect social interactions and perceptions of privacy. As a result, there was backlash against the product leading to its failure. However, today’s attitudes surrounding technology and privacy have further laxed; technological advances have shaped a sociotechnical context where Glass may succeed today or in the future. This paper utilizes Actor Network Theory to demonstrate how Google failed to coalesce a human, non-human network in developing Glass, expanding on prior work to show how the conditions surrounding Glass have evolved with time. To achieve the above conclusions, this paper analyzes media and primary sources from the time of release of Glass, academic and retrospective journalism pertaining to the failure of Glass, interviews with non-experts and experts about this technology, and current Glass enthusiasts via the Google Glass subreddit. Literature Review In April 2013 Google began accepting applications for the public to purchase a pair of smart glasses that Google believed was a major step in the direction of their dream “that computers and the Internet will be accessible anywhere and we can ask them to do things without lifting a finger” (Miller, 2013). This was the Explorer version of Google Glass, outfitted with a small screen and camera, and connected to a smartphone and the internet over Bluetooth or Wifi (Miller, 2013). Essentially a beta test for developers, the purpose of the “Explorer program [was] to find out how people want to (and will) use Glass” (Topolsky, 2013). The expectations around Google Glass were massive, with Business Insider (2013) expecting a $10.5 billion dollar opportunity for Google as unit sales would increase and the price would decrease until Glass was the next “ubiquitous” technology. However, the glasses failed spectacularly with media citing that Google overpromised and underdelivered (Yoon, 2018). Of course, this does not tell the entire story. Many people will not know that Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing, healthcare, and logistics businesses for a workplace hands-off augmented reality computer (“Glass”, 2021). Similarly, Microsoft Hololens allows a headset based industrial mixed reality solution (“Hololens”, 2021). So, if these technologies have proven themselves in a commercial space, what went wrong in the public setting? During Glass’s Explorer phase there was a slew of privacy concerns associated with the fact that wearing Glass meant wielding a camera at all times. To some, Google Glass was a rare example of people pushing back against big tech regarding privacy. People were kicked out of bars because of the recording aspect, the NYT ran a front-page story about privacy concerns, activists set up groups to push back against the product, and policies were implemented that forbid people from taking pictures without consent (Eveleth, 2018). Kudina and Verbeek (2019) explored how Glass mediated the value of privacy by analyzing YouTube comments from the time of release. However, there is little consideration given to the temporal aspects of sociotechnical interaction. It is essential that Glass is examined, not only in the context of its release, but also with respect to changing norms, human perceptions, and technologies. Without asking these questions, we remain unprepared to answer whether a similar technology could succeed today or in the future. “Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy” by Olya Kudina and Paul-Peter Verbeek (2019) examines online discussions about Google Glass, particularly comments on a YouTube video produced by Google, in order to understand “how people articulate new meanings of the value of privacy.” This case study serves as a demonstration of Verbeek’s own Theory of Technological Mediation, which allows a focus on “the dynamics of the interaction between technologies and human values” as a way of addressing the Collingridge Dilemma, which applied here says that when a technology is young it is unknown how it will affect systems, and that by the time the morality surrounding technology is clear, it is difficult to develop the already widespread technology. According to mediation theory, engineers design not just products, but they design human-technological interactions in the world. Technology acts as a mediator, shaping personal experiences and objects while humans and tech are not separate, but affect each other in their relations. Rather than speculating about the future, “it studies the dynamics of technomoral change itself.” While Verbeek’s paper serves as a launch point for human perception around the time of Glass’s release, and is drawn upon greatly in the below analysis, the data set is of course not representative of today’s cultural technological landscape. Therefore, this paper hopes to extend on this work in describing not just Glass’s initial rejection given its social context at the time, but also inspect perceptions of the technology today. Conceptual Frameworks and Research Methods This paper draws mainly on Darryl Cressman’s (2009) overview of Actor Network Theory and the following definitions are derived from his work unless otherwise cited. In Actor Network Theory everything, both human and non-human can be viewed as both an actor and a network. These actor networks are therefore sociotechnical in nature, and they are sometimes referred to as heterogenous networks. A network is defined by the associations it describes; therefore, power of the network and association are intertwined. Additionally, power and meaning are not inherent to any single actor within a network, rather they are associative, relational and contextual. When that actor becomes part of another network its associations change, and as a result its power or meaning changes. Meaning is ascribed to actors with a network contextually rather innately (Cressman, 2009). Engineers in ANT practice heterogeneous engineering, assembling actor networks that are both human and technical in nature. To understand how the world works, practitioners of ANT must understand how economic, political, social, and technological understanding interact with each other. In contrast to other STS theories, ANT is symmetrical in the influence of both the technical and nontechnical (Cressman, 2009). Technological innovation comes from the process in ANT known as translation. This is the process by which both the social and technical actors are recruited into a network. This does not happen at once, rather actors are recruited in a gradient as the network gradually becomes more robust. In understanding the world through ANT, there is an emphasis on connections rather than the individual, and these connections are not all equal (Cressman, 2009). The conclusion of Actor Network Theory is that for a network to succeed, an engineer must consider all actors human, nonhuman, technical, political, economic, social, etc. Engineers are therefore world builders (Law, 1987), and recruiting actors to make a socially robust network is the triumph of a network. Neglecting the social aspects, or encountering rogue actors, leads to a failed network. It will be shown that this is exactly how Google failed as a network builder; thus, the tools of ANT were chosen to explore this dynamic. In addition to the academic papers cited and journalistic releases analyzed below, two means of research were also applied. In order to gain a sense of how potential users today perceive Google Glass or similar technology, interviews were conducted on a group of nonexperts and peers, as well as one industry expert, and enthusiasts of the technology were gauged via posts on the Google Glass enthusiast subreddit “r/googleglass”. The purpose of the interviews was not to poll a representative set of the opinions surrounding Glass, rather to guide research and find some interesting perspectives surrounding the technology and privacy today. Subjects were aged 22 to 57 and varied in occupation, education and sex. All interviewees could be broadly incorporated in a target audience for Google, as all of them consume smart technology already. The interviewees were asked what they knew about Google Glass, then asked a set of questions about smart technology, ubiquitous recording, privacy, and legality, and finally were asked to give their opinion on the viability of a product like Glass coming back in the future. Interviewees’ knowledge regarding Glass ranged from having never heard of the product, to familiarity, to an industry insider who markets technology products for Apple and has worked with former Glass developers. It is important to emphasize that these interviewees were not randomly selected and do not number great enough to act as a focus group of sorts for the product, but they guided research and topic discovery as well as offer a scope of perspectives in this area. The second group considered are users of the subreddit “r/googleglass.” This is an enthusiast forum dedicated to the technology. The studied materials consisted of the forum “Top, This Year” as of March 2021, meaning that these posts were the most “upvoted,” or received the most positive interactions on that forum for the year. These posts were chosen because they represent the most popular current opinions and perceptions from the enthusiast community. Analysis In the case of Glass, Google serves as the network builder in assembling Glass, not just the technology but also the human technical interactions. In ANT, technology and society are dual, in that they exert influence on and shape each other. This is also articulated by Verbeek through his Technological Mediation framework, claiming that Glass mediates privacy itself. In the below section, media from the time of Glass’s release will be analyzed to see how the associations of Glass with these rogue actors lead to the destabilization of the network all together. Moving chronologically, the first article analyzed is from February 2013, nearly two months prior to the launch of the explorer version of Glass. A writer from The Verge met with Google Glass lead designers for an early test of the product. The author of the article is, as expected of a tech magazine writer, very optimistic about Google Glass noting the “tremendous value and potential.” He praises the design, appearance, functionality and wearability of the device but also posts an early warning sign about the fate of Glass: “At one point during my time with Glass, we all went out to navigate to a nearby Starbucks — the camera crew I’d brought with me came along. As soon as we got inside however, the employees at Starbucks asked us to stop filming. Sure, no problem. But I kept the Glass’ video recorder going, all the way through my order and getting my coffee. Yes, you can see a light in the prism when the device is recording, but I got the impression that most people had no idea what they were looking at. The cashier seemed to be on the verge of asking me what I was wearing on my face, but the question never came. He certainly never asked me to stop filming.” (Topolsky, 2013) The author is keenly aware of the issues looming for Google Glass, saying in his own words, “The privacy issue is going to be a big hurdle for Google with Glass”. When he brought this up to the Glass designers he met with (product director Steve Lee and lead industrial designer Isabelle Olsson). Their belief was that the explorer program was their way of developing an etiquette surrounding Glass. The use and misuse of the program would be monitored by Google and feedback would move the product forward. The author then remarks “that’s not going to answer questions about what’s right and wrong to do with a camera that doesn’t need to be held up to take a photo, and often won’t even be noticed by its owner’s subjects. Will people get comfortable with that? Are they supposed to?” (Topolsky, 2013) From an ANT perspective, privacy is not just a concept but rather a socio-technical actor existing in their network. It is equally important for Google to consider how Glass allows people to record the world and affect others notions of privacy. However, there is almost an apathy here in the Explorer program. Google acknowledges that through the Explorer program they can develop an etiquette around Glass, while recruiting people to their network, but without taking an active role in designing a project that is socially harmonious, their network is unstable. As the author stated, their tech fails to answer the questions about what people will do with a camera and if that’s okay. Google’s technological optimism, or potentially their naivete, comes through perhaps strongest in an influential New York Times article from the time of release of Google Glass. This article, titled “Google Glass Picks Up Early Signal: Keep Out” details the negative responses that Google Glass was getting form various places around the country, and contrasts it with Google’s reputation for being cavalier around privacy. The article quotes Google’s former CEO Eric Schmidt in 2009 saying, “If you have something that you don’t want anyone to know, maybe you shouldn’t be doing it in the first place” (Streitfield, 2013). It is clear that this policy permeates through to their implementation of Glass, which potentially immortalizes the public realm through ubiquitous recording, thus making potentially everything known to everyone. A contributing law expert is quoted as saying “We are all now going to be both the paparazzi and the paparazzi’s target” (Streitfield, 2013). Furthermore, the article reports that app developers made photography with glass as discrete as simply winking in one application (Streitfield, 2013). To many this makes Glass even more intrusive, and although it is unclear if Google would have allowed a feature like this in their final release, the Explorer program was essential for gradually recruiting public acceptance into the Glass network. Of course, they failed to do so. The New York Times article also speaks on a Seattle bar that banned Glass. The owner of the bar reported to Geekwire that Glass disrupted the private and seedy culture of his bar: “People want to go there and be not known … and definitely don’t want to be secretly filmed or videotaped and immediately put on the Internet” (Bishop, 2013). He also notes that “tech geeks” from Amazon frequent the bar, and he doesn’t want them using Glass inside. This “tech geek backlash” is another overarching theme regarding these reactionary articles. As one writer put it, “Google’s core mistake was allowing geeky developers to become the face of Glass” (Constine, 2017). This made recruitment of a more privacy conscious group difficult for Google, since all of a sudden there was an Us vs the “Glassholes” dynamic. The Five Point owners, the geeky big tech employees, and its various bargoers represent a key factor that must be considered when assembling a socially robust network. The associations surrounding actors in a network are entirely variable and context dependent. Where Google employees may look favorably on how Glass impacts social dynamics, the same is not true of all society. The heterogenous engineer of ANT does engineering outside the lab creating a network that is socially robust, while Google perhaps looks only inward on its own norms. Kudina and Verbeek’s (2009) paper using Technological Mediation digs deeper into how Google approached human behavior and Glass. Google called on the best judgement of its users and published a list of dos and don’ts surrounding Glass and sat back to observe. The author turns to gauging Glass’s mediation of privacy and social interaction via YouTube comments on this list of dos and don’ts during the explorer phase of Glass. One conclusion is that “Glass appears as a mediating boundary object between what commenters consider private even in the most public places and what is violated when the device is introduced,” and to online commenters “the privacy of forgetting [is] at stake with Glass.” As a designer, under Technological Mediation, Google creates the mediations, and perhaps for Glass to succeed they needed to be aware of what human interactions and perceptions were actually being designed. This wraps into actor network theory nicely, since under ANT designers are responsible for recruiting the actors that are both human and nonhuman to a sociotechnical network. The designers are the builders of society, and Google failed in creating a network that is stable both socially and technically. A few years later, SnapChat created the spectacles which were smart glasses that allowed users to record footage and post to snapchat. However, without addressing the social issues, the same fate occurred and this network too failed as reported by TechCrunch: “Google Glass tainted the market with its ‘not sure if you’re recording me’ design. Even though Snap put more obvious recording signal lights on Spectacles, people would still question you about whether they were on camera. That not only made people uncomfortable being around Spectacles, but made you feel like a bit of a creep just wearing them” (Constine, 2017). This is not to say that there is no hope for augmented reality. Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing and healthcare businesses. In this space the context is completely different, and the expectation of privacy spoken about by Verbeek does not exist in the same caliber. Privacy, under ANT, can be considered an actor-network, since it is defined by humans and technological relations. Therefore, it is also subject to the contextuality present in ANT and takes on a different meaning in the workplace. There is already perhaps an expectation of being observed at work, at least to some extent, and especially in manufacturing settings. Computer surveillance software, security cameras, and sensors in manufacturing monitor people’s actions already in a way that would be unacceptable in the private space. From an ANT perspective this clearly represents the idea of variable meanings of actors in different networks. As a result, Google is able to recruit companies and people to their enterprise network, where associations with privacy hold different meanings. Strictly speaking, the technology for these products to exist was never the problem; rather, Glass, people, and privacy take on different meanings in a business setting and the public space. While Glass may have been initially deemed unacceptable by society, human perceptions are subject to change as a result of the technical landscape that permeates life around us. Much has changed since 2013 when Glass was released. The privacy paradox states that individuals may desire privacy, but are willing to exchange it for the benefits of technology (Eveleth, 2018). What was once considered off limits could potentially now be acceptable, as technology has shaped our views of what is wrong and right. Evidence of this lies in the still active Reddit group dedicated to Google Glass. Users here are still developing software for Glass including the top poster writing about hacking a version of Android onto Glass. There are many posts about buying and selling the technology as well as discussing alternative smart glasses. The discussions in the community consist of instructions on how to load firmware updates onto Glass as well as loading custom apps such as Netflix which is popular among users on the subreddit. Additionally, there are troubleshooting posts, guides, blogs and external repositories of apps discussed, linked and posted on the forum. In stark contrast to the YouTube comments analyzed by Verbeek, these users have embraced Glass and taken on the role of designers in an enthusiast ecosystem. The general consensus here is also a longing or even optimism about new Google Glass products, and that the original Glass was “ahead of its time”. In conducted interviews, while the subjects varied in terms of their individual privacy beliefs, no subject so far has said that Glass or a similar device should be banned. More importantly, there was consensus that a product like Glass could or will exist in the future. One expert who Apple contracts for marketing, said “if Apple released their version of Google Glass in two years it will be everywhere.” Others, especially young people, saw no problem whatsoever with the technology, even after having experts’ concerns explained. The justification was that privacy is already so compromised by technology and governments. Nearly all interviewees believed that if a product like this came out in the future, and was a commercial success they would see no problem at all. Like the reddit users, these interviewees are a far cry from the mainstream privacy worry in 2013. In observing both Reddit posters and interviewees, one cannot determine for certain whether Google Glass could reclaim success today. However, these examples show that the meaning of actor networks can be derived from context that is time dependent as well. Glass is not innately moral or immoral. Rather, Society’s expectations for privacy, and their morals surrounding the subject, change with time and the influence of technology. In Actor Network Theory this is the symmetry of humans affecting technology and technology impacting humans. While Google failed to realize how these human factors played into their network originally, perhaps today or in the near future privacy, as its own actor network, will evolve in such a way that Glass can exist as a socially robust network. Conclusion Google Glass is an actor-network that dissolved, not as a result of its technology or any specific actor, but rather because of the associations and context these human and nonhuman actors take on in translating the network. In a public space, from the beginning Glass represented a form of ubiquitous and secret recording, because there was the assumption that anybody at any time could be caught on the glasses’ camera. Technology mediates human perception, and in this case, Glass lends new meaning to what is considered private. In an Actor Network framework, this is a demonstration of the symmetry of human and non-human artifacts influencing each other, and without these considerations the network was bound to fail. Rather than design a product that was both social and technical, Google maintained its cavalier approach to privacy, not considering how people may have reacted to digitalizing the world’s eyesight. Google employees and glass users at the time were optimistic about the future of the product, believing that the product would come to be socially acceptable. This captures the idea of association and context ascribing meaning in ANT. While Glass may have been acceptable in Silicon Valley, it did not get the same reception in the main stream. Similarly, while Google could not release this product to the public it has faced success in manufacturing, healthcare, and logistic settings as have other augmented reality headsets. Again, here privacy and people’s expectations take on a new meaning in the Google Glass Enterprise actor-network. Much has changed since the release of Google Glass. It has become an expectation in these times that users trade free services for their own personal data. We have all had our ideas of privacy mediated by technology in this way. It may be possible then, that in the current year or in the future a product like Glass will resurface, as it has done in the manufacturing space. Some Reddit users, for example, have put Google Glass to use in their own lives, modifying and distributing updated software for the glasses. The consensus on these forums is that Glass was ahead of its time, and there is consensus among interviewed potential users that a product like this could succeed. From an ANT perspective, again it is clear that the context of associations within the network matter, rather than the individual parts, and these are all dynamic with respect to time. If a product like Glass was to reach mainstream success, it would not be strictly the technology, but rather the recruitment of the technology, the human users, and the social norms of today or the future that yield a stable network. While Google Glass as a high-profile product failure has been written about extensively, there is little in the vein of an STS perspective, and that work focuses on the lens of society at Glasses release date. The efforts of this paper are to provide an example of how the tools of ANT can be used to not only analyze the building (and failure) of a technology, but also emphasize how associations change with context, specifically time. These considerations are essential for understanding not just the deployment of future technologies, but also the transient nature of social norms. References Bishop, T. (2013, March 8). No Google Glasses allowed, declares Seattle dive bar. GeekWire. https://www.geekwire.com/2013/google-glasses-allowed-declares-seattle-dive-bar/ Constine, J. (2017, October 28). Why Snapchat Spectacles failed. TechCrunch. https://social.techcrunch.com/2017/10/28/why-snapchat-spectacles-failed/ Cressman, D. (2009). A Brief Overview of Actor-Network Theory: Punctualization, Heterogeneous Engineering & Translation. https://summit.sfu.ca/item/13593 Eveleth, R (2018). Google Glass Wasn’t a Failure. It Raised Crucial Concerns. WIRED. (n.d.). Retrieved November 1, 2020, from https://www.wired.com/story/google-glass-reasonableexpectation-of-privacy/ Glass. (n.d.). Glass. Retrieved November 2, 2020, from https://www.google.com/glass/start/ Insider, B. (n.d.). BI INTELLIGENCE FORECAST: Google Glass Will Be An $11 Billion Market By 2018. Business Insider. Retrieved November 1, 2020, from https://www.businessinsider.com/google-glass-11-billion-market-by-2018-2013-5 Kudina, O., & Verbeek, P.-P. (2019). Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy. Science, Technology, & Human Values, 44(2), 291–314. https://doi.org/10.1177/0162243918793711 Law, J. (1987). On the Social Explanation of Technical Change: The Case of the Portuguese Maritime Expansion. Technology and Culture, 28(2), 227–252. https://doi.org/10.2307/3105566 Microsoft HoloLens | Mixed Reality Technology for Business. (n.d.). Retrieved March 27, 2021, from https://www.microsoft.com/en-us/hololens Miller, C. C. (2013, February 21). Google Searches for Style. The New York Times. https://www.nytimes.com/2013/02/21/technology/google-looks-to-make-its-computer-glassesstylish.html Streitfeld, D. (2013, May 7). Google Glass Picks Up Early Signal: Keep Out. The New York Times. https://www.nytimes.com/2013/05/07/technology/personaltech/google-glass-picks-up-earlysignal-keep-out.html Topolsky, J. (2013, February 22). I used Google Glass: The future, but with monthly updates. The Verge. https://www.theverge.com/2013/2/22/4013406/i-used-google-glass-its-the-future-withmonthly-updates
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Create a short paragraph response to the question using clear, precise vocabulary. This should only rely on information contained in the text.
EVIDENCE:
Analysis of the Google Glass Failure and Why Things May Be Different Now A Research Paper submitted to the Department of Engineering and Society Presented to the Faculty of the School of Engineering and Applied Science University of Virginia • Charlottesville, Virginia In Partial Fulfillment of the Requirements for the Degree Bachelor of Science, School of Engineering Tyler Labiak Spring, 2021 On my honor as a University Student, I have neither given nor received unauthorized aid on this assignment as defined by the Honor Guidelines for Thesis-Related Assignments Signature __________________________________________ Date __________ Tyler Labiak Approved __________________________________________ Date __________ Sharon Tsai-hsuan Ku, Department of Engineering and Society 5/8/2021 Introduction As technology continues to advance at breakneck speeds into the unknown, humans are increasingly defined by their creations. Inventions alter history, mediate human-perception, deepen (or obscure) knowledge, and modify socialization. Also, throughout history, technology has come to exist through human political, economic, cultural, and social factors (Law, 1987). To best understand and guide the development of technology, and consequently humanity, much work has been done researching the social means by which technology comes to exist and, inversely, the effects of technology on society. Of course, the human drivers behind technology’s development and adoption are not static. Social constructs like privacy, data ethics, safety standards, and social norms change over time as society changes and, consequently, as technology changes. Therefore, technology must be evaluated in the context of its creation and usage. This paper hopes to highlight this temporal element in analyzing technology in the context of a dynamic society. Google Glass is a device that society rejected not as a bad piece of technology, but rather as a socio-technical artifact. The reality of Google Glass is that its engineers did not consciously design the human-technological interaction that they were creating and failed to see how the product would affect social interactions and perceptions of privacy. As a result, there was backlash against the product leading to its failure. However, today’s attitudes surrounding technology and privacy have further laxed; technological advances have shaped a sociotechnical context where Glass may succeed today or in the future. This paper utilizes Actor Network Theory to demonstrate how Google failed to coalesce a human, non-human network in developing Glass, expanding on prior work to show how the conditions surrounding Glass have evolved with time. To achieve the above conclusions, this paper analyzes media and primary sources from the time of release of Glass, academic and retrospective journalism pertaining to the failure of Glass, interviews with non-experts and experts about this technology, and current Glass enthusiasts via the Google Glass subreddit. Literature Review In April 2013 Google began accepting applications for the public to purchase a pair of smart glasses that Google believed was a major step in the direction of their dream “that computers and the Internet will be accessible anywhere and we can ask them to do things without lifting a finger” (Miller, 2013). This was the Explorer version of Google Glass, outfitted with a small screen and camera, and connected to a smartphone and the internet over Bluetooth or Wifi (Miller, 2013). Essentially a beta test for developers, the purpose of the “Explorer program [was] to find out how people want to (and will) use Glass” (Topolsky, 2013). The expectations around Google Glass were massive, with Business Insider (2013) expecting a $10.5 billion dollar opportunity for Google as unit sales would increase and the price would decrease until Glass was the next “ubiquitous” technology. However, the glasses failed spectacularly with media citing that Google overpromised and underdelivered (Yoon, 2018). Of course, this does not tell the entire story. Many people will not know that Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing, healthcare, and logistics businesses for a workplace hands-off augmented reality computer (“Glass”, 2021). Similarly, Microsoft Hololens allows a headset based industrial mixed reality solution (“Hololens”, 2021). So, if these technologies have proven themselves in a commercial space, what went wrong in the public setting? During Glass’s Explorer phase there was a slew of privacy concerns associated with the fact that wearing Glass meant wielding a camera at all times. To some, Google Glass was a rare example of people pushing back against big tech regarding privacy. People were kicked out of bars because of the recording aspect, the NYT ran a front-page story about privacy concerns, activists set up groups to push back against the product, and policies were implemented that forbid people from taking pictures without consent (Eveleth, 2018). Kudina and Verbeek (2019) explored how Glass mediated the value of privacy by analyzing YouTube comments from the time of release. However, there is little consideration given to the temporal aspects of sociotechnical interaction. It is essential that Glass is examined, not only in the context of its release, but also with respect to changing norms, human perceptions, and technologies. Without asking these questions, we remain unprepared to answer whether a similar technology could succeed today or in the future. “Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy” by Olya Kudina and Paul-Peter Verbeek (2019) examines online discussions about Google Glass, particularly comments on a YouTube video produced by Google, in order to understand “how people articulate new meanings of the value of privacy.” This case study serves as a demonstration of Verbeek’s own Theory of Technological Mediation, which allows a focus on “the dynamics of the interaction between technologies and human values” as a way of addressing the Collingridge Dilemma, which applied here says that when a technology is young it is unknown how it will affect systems, and that by the time the morality surrounding technology is clear, it is difficult to develop the already widespread technology. According to mediation theory, engineers design not just products, but they design human-technological interactions in the world. Technology acts as a mediator, shaping personal experiences and objects while humans and tech are not separate, but affect each other in their relations. Rather than speculating about the future, “it studies the dynamics of technomoral change itself.” While Verbeek’s paper serves as a launch point for human perception around the time of Glass’s release, and is drawn upon greatly in the below analysis, the data set is of course not representative of today’s cultural technological landscape. Therefore, this paper hopes to extend on this work in describing not just Glass’s initial rejection given its social context at the time, but also inspect perceptions of the technology today. Conceptual Frameworks and Research Methods This paper draws mainly on Darryl Cressman’s (2009) overview of Actor Network Theory and the following definitions are derived from his work unless otherwise cited. In Actor Network Theory everything, both human and non-human can be viewed as both an actor and a network. These actor networks are therefore sociotechnical in nature, and they are sometimes referred to as heterogenous networks. A network is defined by the associations it describes; therefore, power of the network and association are intertwined. Additionally, power and meaning are not inherent to any single actor within a network, rather they are associative, relational and contextual. When that actor becomes part of another network its associations change, and as a result its power or meaning changes. Meaning is ascribed to actors with a network contextually rather innately (Cressman, 2009). Engineers in ANT practice heterogeneous engineering, assembling actor networks that are both human and technical in nature. To understand how the world works, practitioners of ANT must understand how economic, political, social, and technological understanding interact with each other. In contrast to other STS theories, ANT is symmetrical in the influence of both the technical and nontechnical (Cressman, 2009). Technological innovation comes from the process in ANT known as translation. This is the process by which both the social and technical actors are recruited into a network. This does not happen at once, rather actors are recruited in a gradient as the network gradually becomes more robust. In understanding the world through ANT, there is an emphasis on connections rather than the individual, and these connections are not all equal (Cressman, 2009). The conclusion of Actor Network Theory is that for a network to succeed, an engineer must consider all actors human, nonhuman, technical, political, economic, social, etc. Engineers are therefore world builders (Law, 1987), and recruiting actors to make a socially robust network is the triumph of a network. Neglecting the social aspects, or encountering rogue actors, leads to a failed network. It will be shown that this is exactly how Google failed as a network builder; thus, the tools of ANT were chosen to explore this dynamic. In addition to the academic papers cited and journalistic releases analyzed below, two means of research were also applied. In order to gain a sense of how potential users today perceive Google Glass or similar technology, interviews were conducted on a group of nonexperts and peers, as well as one industry expert, and enthusiasts of the technology were gauged via posts on the Google Glass enthusiast subreddit “r/googleglass”. The purpose of the interviews was not to poll a representative set of the opinions surrounding Glass, rather to guide research and find some interesting perspectives surrounding the technology and privacy today. Subjects were aged 22 to 57 and varied in occupation, education and sex. All interviewees could be broadly incorporated in a target audience for Google, as all of them consume smart technology already. The interviewees were asked what they knew about Google Glass, then asked a set of questions about smart technology, ubiquitous recording, privacy, and legality, and finally were asked to give their opinion on the viability of a product like Glass coming back in the future. Interviewees’ knowledge regarding Glass ranged from having never heard of the product, to familiarity, to an industry insider who markets technology products for Apple and has worked with former Glass developers. It is important to emphasize that these interviewees were not randomly selected and do not number great enough to act as a focus group of sorts for the product, but they guided research and topic discovery as well as offer a scope of perspectives in this area. The second group considered are users of the subreddit “r/googleglass.” This is an enthusiast forum dedicated to the technology. The studied materials consisted of the forum “Top, This Year” as of March 2021, meaning that these posts were the most “upvoted,” or received the most positive interactions on that forum for the year. These posts were chosen because they represent the most popular current opinions and perceptions from the enthusiast community. Analysis In the case of Glass, Google serves as the network builder in assembling Glass, not just the technology but also the human technical interactions. In ANT, technology and society are dual, in that they exert influence on and shape each other. This is also articulated by Verbeek through his Technological Mediation framework, claiming that Glass mediates privacy itself. In the below section, media from the time of Glass’s release will be analyzed to see how the associations of Glass with these rogue actors lead to the destabilization of the network all together. Moving chronologically, the first article analyzed is from February 2013, nearly two months prior to the launch of the explorer version of Glass. A writer from The Verge met with Google Glass lead designers for an early test of the product. The author of the article is, as expected of a tech magazine writer, very optimistic about Google Glass noting the “tremendous value and potential.” He praises the design, appearance, functionality and wearability of the device but also posts an early warning sign about the fate of Glass: “At one point during my time with Glass, we all went out to navigate to a nearby Starbucks — the camera crew I’d brought with me came along. As soon as we got inside however, the employees at Starbucks asked us to stop filming. Sure, no problem. But I kept the Glass’ video recorder going, all the way through my order and getting my coffee. Yes, you can see a light in the prism when the device is recording, but I got the impression that most people had no idea what they were looking at. The cashier seemed to be on the verge of asking me what I was wearing on my face, but the question never came. He certainly never asked me to stop filming.” (Topolsky, 2013) The author is keenly aware of the issues looming for Google Glass, saying in his own words, “The privacy issue is going to be a big hurdle for Google with Glass”. When he brought this up to the Glass designers he met with (product director Steve Lee and lead industrial designer Isabelle Olsson). Their belief was that the explorer program was their way of developing an etiquette surrounding Glass. The use and misuse of the program would be monitored by Google and feedback would move the product forward. The author then remarks “that’s not going to answer questions about what’s right and wrong to do with a camera that doesn’t need to be held up to take a photo, and often won’t even be noticed by its owner’s subjects. Will people get comfortable with that? Are they supposed to?” (Topolsky, 2013) From an ANT perspective, privacy is not just a concept but rather a socio-technical actor existing in their network. It is equally important for Google to consider how Glass allows people to record the world and affect others notions of privacy. However, there is almost an apathy here in the Explorer program. Google acknowledges that through the Explorer program they can develop an etiquette around Glass, while recruiting people to their network, but without taking an active role in designing a project that is socially harmonious, their network is unstable. As the author stated, their tech fails to answer the questions about what people will do with a camera and if that’s okay. Google’s technological optimism, or potentially their naivete, comes through perhaps strongest in an influential New York Times article from the time of release of Google Glass. This article, titled “Google Glass Picks Up Early Signal: Keep Out” details the negative responses that Google Glass was getting form various places around the country, and contrasts it with Google’s reputation for being cavalier around privacy. The article quotes Google’s former CEO Eric Schmidt in 2009 saying, “If you have something that you don’t want anyone to know, maybe you shouldn’t be doing it in the first place” (Streitfield, 2013). It is clear that this policy permeates through to their implementation of Glass, which potentially immortalizes the public realm through ubiquitous recording, thus making potentially everything known to everyone. A contributing law expert is quoted as saying “We are all now going to be both the paparazzi and the paparazzi’s target” (Streitfield, 2013). Furthermore, the article reports that app developers made photography with glass as discrete as simply winking in one application (Streitfield, 2013). To many this makes Glass even more intrusive, and although it is unclear if Google would have allowed a feature like this in their final release, the Explorer program was essential for gradually recruiting public acceptance into the Glass network. Of course, they failed to do so. The New York Times article also speaks on a Seattle bar that banned Glass. The owner of the bar reported to Geekwire that Glass disrupted the private and seedy culture of his bar: “People want to go there and be not known … and definitely don’t want to be secretly filmed or videotaped and immediately put on the Internet” (Bishop, 2013). He also notes that “tech geeks” from Amazon frequent the bar, and he doesn’t want them using Glass inside. This “tech geek backlash” is another overarching theme regarding these reactionary articles. As one writer put it, “Google’s core mistake was allowing geeky developers to become the face of Glass” (Constine, 2017). This made recruitment of a more privacy conscious group difficult for Google, since all of a sudden there was an Us vs the “Glassholes” dynamic. The Five Point owners, the geeky big tech employees, and its various bargoers represent a key factor that must be considered when assembling a socially robust network. The associations surrounding actors in a network are entirely variable and context dependent. Where Google employees may look favorably on how Glass impacts social dynamics, the same is not true of all society. The heterogenous engineer of ANT does engineering outside the lab creating a network that is socially robust, while Google perhaps looks only inward on its own norms. Kudina and Verbeek’s (2009) paper using Technological Mediation digs deeper into how Google approached human behavior and Glass. Google called on the best judgement of its users and published a list of dos and don’ts surrounding Glass and sat back to observe. The author turns to gauging Glass’s mediation of privacy and social interaction via YouTube comments on this list of dos and don’ts during the explorer phase of Glass. One conclusion is that “Glass appears as a mediating boundary object between what commenters consider private even in the most public places and what is violated when the device is introduced,” and to online commenters “the privacy of forgetting [is] at stake with Glass.” As a designer, under Technological Mediation, Google creates the mediations, and perhaps for Glass to succeed they needed to be aware of what human interactions and perceptions were actually being designed. This wraps into actor network theory nicely, since under ANT designers are responsible for recruiting the actors that are both human and nonhuman to a sociotechnical network. The designers are the builders of society, and Google failed in creating a network that is stable both socially and technically. A few years later, SnapChat created the spectacles which were smart glasses that allowed users to record footage and post to snapchat. However, without addressing the social issues, the same fate occurred and this network too failed as reported by TechCrunch: “Google Glass tainted the market with its ‘not sure if you’re recording me’ design. Even though Snap put more obvious recording signal lights on Spectacles, people would still question you about whether they were on camera. That not only made people uncomfortable being around Spectacles, but made you feel like a bit of a creep just wearing them” (Constine, 2017). This is not to say that there is no hope for augmented reality. Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing and healthcare businesses. In this space the context is completely different, and the expectation of privacy spoken about by Verbeek does not exist in the same caliber. Privacy, under ANT, can be considered an actor-network, since it is defined by humans and technological relations. Therefore, it is also subject to the contextuality present in ANT and takes on a different meaning in the workplace. There is already perhaps an expectation of being observed at work, at least to some extent, and especially in manufacturing settings. Computer surveillance software, security cameras, and sensors in manufacturing monitor people’s actions already in a way that would be unacceptable in the private space. From an ANT perspective this clearly represents the idea of variable meanings of actors in different networks. As a result, Google is able to recruit companies and people to their enterprise network, where associations with privacy hold different meanings. Strictly speaking, the technology for these products to exist was never the problem; rather, Glass, people, and privacy take on different meanings in a business setting and the public space. While Glass may have been initially deemed unacceptable by society, human perceptions are subject to change as a result of the technical landscape that permeates life around us. Much has changed since 2013 when Glass was released. The privacy paradox states that individuals may desire privacy, but are willing to exchange it for the benefits of technology (Eveleth, 2018). What was once considered off limits could potentially now be acceptable, as technology has shaped our views of what is wrong and right. Evidence of this lies in the still active Reddit group dedicated to Google Glass. Users here are still developing software for Glass including the top poster writing about hacking a version of Android onto Glass. There are many posts about buying and selling the technology as well as discussing alternative smart glasses. The discussions in the community consist of instructions on how to load firmware updates onto Glass as well as loading custom apps such as Netflix which is popular among users on the subreddit. Additionally, there are troubleshooting posts, guides, blogs and external repositories of apps discussed, linked and posted on the forum. In stark contrast to the YouTube comments analyzed by Verbeek, these users have embraced Glass and taken on the role of designers in an enthusiast ecosystem. The general consensus here is also a longing or even optimism about new Google Glass products, and that the original Glass was “ahead of its time”. In conducted interviews, while the subjects varied in terms of their individual privacy beliefs, no subject so far has said that Glass or a similar device should be banned. More importantly, there was consensus that a product like Glass could or will exist in the future. One expert who Apple contracts for marketing, said “if Apple released their version of Google Glass in two years it will be everywhere.” Others, especially young people, saw no problem whatsoever with the technology, even after having experts’ concerns explained. The justification was that privacy is already so compromised by technology and governments. Nearly all interviewees believed that if a product like this came out in the future, and was a commercial success they would see no problem at all. Like the reddit users, these interviewees are a far cry from the mainstream privacy worry in 2013. In observing both Reddit posters and interviewees, one cannot determine for certain whether Google Glass could reclaim success today. However, these examples show that the meaning of actor networks can be derived from context that is time dependent as well. Glass is not innately moral or immoral. Rather, Society’s expectations for privacy, and their morals surrounding the subject, change with time and the influence of technology. In Actor Network Theory this is the symmetry of humans affecting technology and technology impacting humans. While Google failed to realize how these human factors played into their network originally, perhaps today or in the near future privacy, as its own actor network, will evolve in such a way that Glass can exist as a socially robust network. Conclusion Google Glass is an actor-network that dissolved, not as a result of its technology or any specific actor, but rather because of the associations and context these human and nonhuman actors take on in translating the network. In a public space, from the beginning Glass represented a form of ubiquitous and secret recording, because there was the assumption that anybody at any time could be caught on the glasses’ camera. Technology mediates human perception, and in this case, Glass lends new meaning to what is considered private. In an Actor Network framework, this is a demonstration of the symmetry of human and non-human artifacts influencing each other, and without these considerations the network was bound to fail. Rather than design a product that was both social and technical, Google maintained its cavalier approach to privacy, not considering how people may have reacted to digitalizing the world’s eyesight. Google employees and glass users at the time were optimistic about the future of the product, believing that the product would come to be socially acceptable. This captures the idea of association and context ascribing meaning in ANT. While Glass may have been acceptable in Silicon Valley, it did not get the same reception in the main stream. Similarly, while Google could not release this product to the public it has faced success in manufacturing, healthcare, and logistic settings as have other augmented reality headsets. Again, here privacy and people’s expectations take on a new meaning in the Google Glass Enterprise actor-network. Much has changed since the release of Google Glass. It has become an expectation in these times that users trade free services for their own personal data. We have all had our ideas of privacy mediated by technology in this way. It may be possible then, that in the current year or in the future a product like Glass will resurface, as it has done in the manufacturing space. Some Reddit users, for example, have put Google Glass to use in their own lives, modifying and distributing updated software for the glasses. The consensus on these forums is that Glass was ahead of its time, and there is consensus among interviewed potential users that a product like this could succeed. From an ANT perspective, again it is clear that the context of associations within the network matter, rather than the individual parts, and these are all dynamic with respect to time. If a product like Glass was to reach mainstream success, it would not be strictly the technology, but rather the recruitment of the technology, the human users, and the social norms of today or the future that yield a stable network. While Google Glass as a high-profile product failure has been written about extensively, there is little in the vein of an STS perspective, and that work focuses on the lens of society at Glasses release date. The efforts of this paper are to provide an example of how the tools of ANT can be used to not only analyze the building (and failure) of a technology, but also emphasize how associations change with context, specifically time. These considerations are essential for understanding not just the deployment of future technologies, but also the transient nature of social norms. References Bishop, T. (2013, March 8). No Google Glasses allowed, declares Seattle dive bar. GeekWire. https://www.geekwire.com/2013/google-glasses-allowed-declares-seattle-dive-bar/ Constine, J. (2017, October 28). Why Snapchat Spectacles failed. TechCrunch. https://social.techcrunch.com/2017/10/28/why-snapchat-spectacles-failed/ Cressman, D. (2009). A Brief Overview of Actor-Network Theory: Punctualization, Heterogeneous Engineering & Translation. https://summit.sfu.ca/item/13593 Eveleth, R (2018). Google Glass Wasn’t a Failure. It Raised Crucial Concerns. WIRED. (n.d.). Retrieved November 1, 2020, from https://www.wired.com/story/google-glass-reasonableexpectation-of-privacy/ Glass. (n.d.). Glass. Retrieved November 2, 2020, from https://www.google.com/glass/start/ Insider, B. (n.d.). BI INTELLIGENCE FORECAST: Google Glass Will Be An $11 Billion Market By 2018. Business Insider. Retrieved November 1, 2020, from https://www.businessinsider.com/google-glass-11-billion-market-by-2018-2013-5 Kudina, O., & Verbeek, P.-P. (2019). Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy. Science, Technology, & Human Values, 44(2), 291–314. https://doi.org/10.1177/0162243918793711 Law, J. (1987). On the Social Explanation of Technical Change: The Case of the Portuguese Maritime Expansion. Technology and Culture, 28(2), 227–252. https://doi.org/10.2307/3105566 Microsoft HoloLens | Mixed Reality Technology for Business. (n.d.). Retrieved March 27, 2021, from https://www.microsoft.com/en-us/hololens Miller, C. C. (2013, February 21). Google Searches for Style. The New York Times. https://www.nytimes.com/2013/02/21/technology/google-looks-to-make-its-computer-glassesstylish.html Streitfeld, D. (2013, May 7). Google Glass Picks Up Early Signal: Keep Out. The New York Times. https://www.nytimes.com/2013/05/07/technology/personaltech/google-glass-picks-up-earlysignal-keep-out.html Topolsky, J. (2013, February 22). I used Google Glass: The future, but with monthly updates. The Verge. https://www.theverge.com/2013/2/22/4013406/i-used-google-glass-its-the-future-withmonthly-updates
USER:
What is Actor Network Theory, and how does it help us understand the failure of Google Glass?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 22 | 17 | 4,535 | null | 273 |
You may only use information from the text in the prompt; use no outside or internal sources of knowledge or information.
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What's Biden's involvement with this?
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U.S. Policies Several executive branch and congressional actions have set the stage for increased development and deployment of offshore wind energy on the U.S. OCS.13 For example, Section 388 of the Energy Policy Act of 2005 (P.L. 109-58) amended the Outer Continental Shelf Lands Act (43 U.S.C. §§1331-1356c) to authorize the Secretary of the Interior to offer leases, easements, and rights-of-way for offshore renewable energy activities on the U.S. OCS.14 BOEM is the lead agency for the U.S. OCS renewable energy leasing program.15 In the 117th Congress, Section 50251 of the Inflation Reduction Act of 2022 (P.L. 117-196) expanded BOEM’s authority to pursue offshore wind leasing in federal waters in the southeastern Atlantic region, in the eastern Gulf of Mexico, and off U.S. territories.16 On the executive side, the Biden Administration suggested a doubling of offshore wind by 2030 as one potential approach to address climate change in Executive Order (E.O.) 14008, “Tackling the Climate Crisis at Home and Abroad.”17 In March 2021, the Biden Administration announced a government-wide effort to deploy 30 gigawatts (or 30,000 megawatts) of offshore wind energy by 2030.18 In September 2022, the Administration announced a related goal to deploy 15 gigawatts (or 15,000 megawatts) of installed floating offshore wind (i.e., structures that are not set into the ocean floor) by 2035.19 As of December 2023, BOEM has conducted 12 competitive wind energy lease sales for areas on the OCS, representing more than 2.5 million acres of commercial wind energy lease areas offshore of Delaware, Louisiana, Maryland, Massachusetts, New Jersey, New York, North Carolina, Rhode Island, South Carolina, Virginia, and California.20 Background on Offshore Wind Energy Project Development Stakeholders have expressed concerns regarding potential impacts to the marine ecosystem and associated species that pertain to offshore wind project activities associated with site development, construction, operation, and decommissioning.21 The following sections provide background on offshore wind energy turbine structures and discuss activities associated with offshore wind projects, including the potential impacts of these activities on the marine ecosystem and species. Potential Impacts of Offshore Wind Energy on the Marine Ecosystem and Associated Species Offshore wind projects may affect the marine ecosystem and associated species. Not all impacts may be adverse; some may be beneficial (e.g., the artificial reef effect, discussed below). In general, OWF activities can impact wildlife through atmospheric and oceanic change,43 • marine habitat alteration, • collision risk, • electromagnetic field (EMF) effects associated with power cables,44 • noise effects, and • water quality (e.g., pollution).45 The scientific literature analyzes the short-term adverse impacts and benefits of offshore wind development to marine mammals, invertebrates, fish, sea turtles, birds, bats, and other components of the marine ecosystem (Table 1).46 Modeling and observational studies (mostly derived from the North Sea) show that most impacts (e.g., habitat alteration) occur within the immediate vicinity of the wind turbine array, with other impacts (e.g., noise effects) extending up to tens of kilometers outside the array.47 Some of these analyses use land-based wind energy observations to model potential offshore wind scenarios, and other analyses extrapolate observations from existing OWFs (again, mostly in the North Sea) to planned offshore wind energy projects. Other potential impacts are informed by laboratory studies mimicking conditions (e.g., noise levels) often associated with offshore wind projects. The sections below discuss the potential OWF impacts (both adverse and beneficial) to the ocean environment and selected wildlife. Issues for Congress The full extent of impacts of offshore wind activities on the marine ecosystem of the U.S. OCS remains unclear, in part because the development of U.S. offshore wind projects is relatively recent. If interest in the climate mitigation benefits derived from offshore wind energy grows in the United States and BOEM continues to issue leases for offshore wind development, Congress may continue to consider how offshore wind energy development may impact the marine ecosystem and associated species.231 In the 118th Congress, some Members called for additional research into the potential harm offshore wind projects may cause to marine wildlife or expressed concern about the potential impacts offshore wind activities might have on other ocean uses (e.g., H.R. 1).
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You may only use information from the text in the prompt; use no outside or internal sources of knowledge or information. What's Biden's involvement with this? U.S. Policies Several executive branch and congressional actions have set the stage for increased development and deployment of offshore wind energy on the U.S. OCS.13 For example, Section 388 of the Energy Policy Act of 2005 (P.L. 109-58) amended the Outer Continental Shelf Lands Act (43 U.S.C. §§1331-1356c) to authorize the Secretary of the Interior to offer leases, easements, and rights-of-way for offshore renewable energy activities on the U.S. OCS.14 BOEM is the lead agency for the U.S. OCS renewable energy leasing program.15 In the 117th Congress, Section 50251 of the Inflation Reduction Act of 2022 (P.L. 117-196) expanded BOEM’s authority to pursue offshore wind leasing in federal waters in the southeastern Atlantic region, in the eastern Gulf of Mexico, and off U.S. territories.16 On the executive side, the Biden Administration suggested a doubling of offshore wind by 2030 as one potential approach to address climate change in Executive Order (E.O.) 14008, “Tackling the Climate Crisis at Home and Abroad.”17 In March 2021, the Biden Administration announced a government-wide effort to deploy 30 gigawatts (or 30,000 megawatts) of offshore wind energy by 2030.18 In September 2022, the Administration announced a related goal to deploy 15 gigawatts (or 15,000 megawatts) of installed floating offshore wind (i.e., structures that are not set into the ocean floor) by 2035.19 As of December 2023, BOEM has conducted 12 competitive wind energy lease sales for areas on the OCS, representing more than 2.5 million acres of commercial wind energy lease areas offshore of Delaware, Louisiana, Maryland, Massachusetts, New Jersey, New York, North Carolina, Rhode Island, South Carolina, Virginia, and California.20 Background on Offshore Wind Energy Project Development Stakeholders have expressed concerns regarding potential impacts to the marine ecosystem and associated species that pertain to offshore wind project activities associated with site development, construction, operation, and decommissioning.21 The following sections provide background on offshore wind energy turbine structures and discuss activities associated with offshore wind projects, including the potential impacts of these activities on the marine ecosystem and species. Potential Impacts of Offshore Wind Energy on the Marine Ecosystem and Associated Species Offshore wind projects may affect the marine ecosystem and associated species. Not all impacts may be adverse; some may be beneficial (e.g., the artificial reef effect, discussed below). In general, OWF activities can impact wildlife through atmospheric and oceanic change,43 • marine habitat alteration, • collision risk, • electromagnetic field (EMF) effects associated with power cables,44 • noise effects, and • water quality (e.g., pollution).45 The scientific literature analyzes the short-term adverse impacts and benefits of offshore wind development to marine mammals, invertebrates, fish, sea turtles, birds, bats, and other components of the marine ecosystem (Table 1).46 Modeling and observational studies (mostly derived from the North Sea) show that most impacts (e.g., habitat alteration) occur within the immediate vicinity of the wind turbine array, with other impacts (e.g., noise effects) extending up to tens of kilometers outside the array.47 Some of these analyses use land-based wind energy observations to model potential offshore wind scenarios, and other analyses extrapolate observations from existing OWFs (again, mostly in the North Sea) to planned offshore wind energy projects. Other potential impacts are informed by laboratory studies mimicking conditions (e.g., noise levels) often associated with offshore wind projects. The sections below discuss the potential OWF impacts (both adverse and beneficial) to the ocean environment and selected wildlife. Issues for Congress The full extent of impacts of offshore wind activities on the marine ecosystem of the U.S. OCS remains unclear, in part because the development of U.S. offshore wind projects is relatively recent. If interest in the climate mitigation benefits derived from offshore wind energy grows in the United States and BOEM continues to issue leases for offshore wind development, Congress may continue to consider how offshore wind energy development may impact the marine ecosystem and associated species.231 In the 118th Congress, some Members called for additional research into the potential harm offshore wind projects may cause to marine wildlife or expressed concern about the potential impacts offshore wind activities might have on other ocean uses (e.g., H.R. 1).
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You may only use information from the text in the prompt; use no outside or internal sources of knowledge or information.
EVIDENCE:
U.S. Policies Several executive branch and congressional actions have set the stage for increased development and deployment of offshore wind energy on the U.S. OCS.13 For example, Section 388 of the Energy Policy Act of 2005 (P.L. 109-58) amended the Outer Continental Shelf Lands Act (43 U.S.C. §§1331-1356c) to authorize the Secretary of the Interior to offer leases, easements, and rights-of-way for offshore renewable energy activities on the U.S. OCS.14 BOEM is the lead agency for the U.S. OCS renewable energy leasing program.15 In the 117th Congress, Section 50251 of the Inflation Reduction Act of 2022 (P.L. 117-196) expanded BOEM’s authority to pursue offshore wind leasing in federal waters in the southeastern Atlantic region, in the eastern Gulf of Mexico, and off U.S. territories.16 On the executive side, the Biden Administration suggested a doubling of offshore wind by 2030 as one potential approach to address climate change in Executive Order (E.O.) 14008, “Tackling the Climate Crisis at Home and Abroad.”17 In March 2021, the Biden Administration announced a government-wide effort to deploy 30 gigawatts (or 30,000 megawatts) of offshore wind energy by 2030.18 In September 2022, the Administration announced a related goal to deploy 15 gigawatts (or 15,000 megawatts) of installed floating offshore wind (i.e., structures that are not set into the ocean floor) by 2035.19 As of December 2023, BOEM has conducted 12 competitive wind energy lease sales for areas on the OCS, representing more than 2.5 million acres of commercial wind energy lease areas offshore of Delaware, Louisiana, Maryland, Massachusetts, New Jersey, New York, North Carolina, Rhode Island, South Carolina, Virginia, and California.20 Background on Offshore Wind Energy Project Development Stakeholders have expressed concerns regarding potential impacts to the marine ecosystem and associated species that pertain to offshore wind project activities associated with site development, construction, operation, and decommissioning.21 The following sections provide background on offshore wind energy turbine structures and discuss activities associated with offshore wind projects, including the potential impacts of these activities on the marine ecosystem and species. Potential Impacts of Offshore Wind Energy on the Marine Ecosystem and Associated Species Offshore wind projects may affect the marine ecosystem and associated species. Not all impacts may be adverse; some may be beneficial (e.g., the artificial reef effect, discussed below). In general, OWF activities can impact wildlife through atmospheric and oceanic change,43 • marine habitat alteration, • collision risk, • electromagnetic field (EMF) effects associated with power cables,44 • noise effects, and • water quality (e.g., pollution).45 The scientific literature analyzes the short-term adverse impacts and benefits of offshore wind development to marine mammals, invertebrates, fish, sea turtles, birds, bats, and other components of the marine ecosystem (Table 1).46 Modeling and observational studies (mostly derived from the North Sea) show that most impacts (e.g., habitat alteration) occur within the immediate vicinity of the wind turbine array, with other impacts (e.g., noise effects) extending up to tens of kilometers outside the array.47 Some of these analyses use land-based wind energy observations to model potential offshore wind scenarios, and other analyses extrapolate observations from existing OWFs (again, mostly in the North Sea) to planned offshore wind energy projects. Other potential impacts are informed by laboratory studies mimicking conditions (e.g., noise levels) often associated with offshore wind projects. The sections below discuss the potential OWF impacts (both adverse and beneficial) to the ocean environment and selected wildlife. Issues for Congress The full extent of impacts of offshore wind activities on the marine ecosystem of the U.S. OCS remains unclear, in part because the development of U.S. offshore wind projects is relatively recent. If interest in the climate mitigation benefits derived from offshore wind energy grows in the United States and BOEM continues to issue leases for offshore wind development, Congress may continue to consider how offshore wind energy development may impact the marine ecosystem and associated species.231 In the 118th Congress, some Members called for additional research into the potential harm offshore wind projects may cause to marine wildlife or expressed concern about the potential impacts offshore wind activities might have on other ocean uses (e.g., H.R. 1).
USER:
What's Biden's involvement with this?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 21 | 5 | 679 | null | 579 |
Answer this question using only the text provided. Do not include additional online sourcing.
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What is a catalyst fee?
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**TALKING TURKEY: IMPACT FUND FILES AMICUS BRIEF TO PROTECT CATALYST FEES FOR PLAINTIFFS** Nov 14 Meredith Dixon, Impact Fund Law Fellow Last week, the Impact Fund and fifteen fellow public interest legal organizations filed an amicus brief in the California Court of Appeals defending plaintiffs’ right to catalyst fees in public interest lawsuits. “Catalyst fees” are one type of attorneys’ fees designed to compensate attorney time spent on public interest lawsuits that catalyze a change in the defendant’s behavior. Not only do catalyst fees incentivize private enforcement, but they also address a specific and serious concern. Plaintiffs face the risk that defendants will vigorously litigate for months or years and then—on the eve of or during trial—fix the very problem challenged in the litigation, moot the case, and escape compensating plaintiffs for the time and effort required to call attention to the problem. In Direct Action Everywhere v. Diestel Turkey Ranch, the plaintiff encountered just this situation after it filed a false advertising lawsuit alleging that Diestel was deceiving customers about the condition in which it kept animals on its properties. Several days into the trial, Diestel voluntarily removed the allegedly false statements from its website as part of a “website refresh.” Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The trial court denied Direct Action’s motion for catalyst fees for multiple reasons, two of which stood out to the Impact Fund and its allies. First, the court scorned the plaintiff’s reason for bringing the lawsuit and, second, it criticized the plaintiff’s activities outside the courtroom. Ultimately, the court held that plaintiffs do not deserve fees when they file litigation consistent with their organizational goals or fail to behave in a manner “above reproach” before and during the litigation. Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The State Legislature and Supreme Court have defined the factors that determine whether a plaintiff is entitled to attorneys’ fees, and the trial court’s order bore little resemblance to the established analysis. If the trial court’s reasoning is allowed to stand, courts could withhold fees simply because an organizational plaintiff files mission-aligned litigation or acts in a manner that displeases them, from issuing press releases to engaging in protests or policy advocacy, regardless of whether those acts violate any law or have any effect on the litigation. This is not what the legislature or supreme court intended. California courts have long recognized that catalyst fees are key to encouraging public interest litigation, and the Impact Fund and amici continue to defend the proper catalyst fee analysis.
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{Article} ================== **TALKING TURKEY: IMPACT FUND FILES AMICUS BRIEF TO PROTECT CATALYST FEES FOR PLAINTIFFS** Nov 14 Meredith Dixon, Impact Fund Law Fellow Last week, the Impact Fund and fifteen fellow public interest legal organizations filed an amicus brief in the California Court of Appeals defending plaintiffs’ right to catalyst fees in public interest lawsuits. “Catalyst fees” are one type of attorneys’ fees designed to compensate attorney time spent on public interest lawsuits that catalyze a change in the defendant’s behavior. Not only do catalyst fees incentivize private enforcement, but they also address a specific and serious concern. Plaintiffs face the risk that defendants will vigorously litigate for months or years and then—on the eve of or during trial—fix the very problem challenged in the litigation, moot the case, and escape compensating plaintiffs for the time and effort required to call attention to the problem. In Direct Action Everywhere v. Diestel Turkey Ranch, the plaintiff encountered just this situation after it filed a false advertising lawsuit alleging that Diestel was deceiving customers about the condition in which it kept animals on its properties. Several days into the trial, Diestel voluntarily removed the allegedly false statements from its website as part of a “website refresh.” Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The trial court denied Direct Action’s motion for catalyst fees for multiple reasons, two of which stood out to the Impact Fund and its allies. First, the court scorned the plaintiff’s reason for bringing the lawsuit and, second, it criticized the plaintiff’s activities outside the courtroom. Ultimately, the court held that plaintiffs do not deserve fees when they file litigation consistent with their organizational goals or fail to behave in a manner “above reproach” before and during the litigation. Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The State Legislature and Supreme Court have defined the factors that determine whether a plaintiff is entitled to attorneys’ fees, and the trial court’s order bore little resemblance to the established analysis. If the trial court’s reasoning is allowed to stand, courts could withhold fees simply because an organizational plaintiff files mission-aligned litigation or acts in a manner that displeases them, from issuing press releases to engaging in protests or policy advocacy, regardless of whether those acts violate any law or have any effect on the litigation. This is not what the legislature or supreme court intended. California courts have long recognized that catalyst fees are key to encouraging public interest litigation, and the Impact Fund and amici continue to defend the proper catalyst fee analysis. ================ {Task Information} ================== Answer this question using only the text provided. Do not include additional online sourcing. ================ {Query} ================== What is a catalyst fee?
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Answer this question using only the text provided. Do not include additional online sourcing.
EVIDENCE:
**TALKING TURKEY: IMPACT FUND FILES AMICUS BRIEF TO PROTECT CATALYST FEES FOR PLAINTIFFS** Nov 14 Meredith Dixon, Impact Fund Law Fellow Last week, the Impact Fund and fifteen fellow public interest legal organizations filed an amicus brief in the California Court of Appeals defending plaintiffs’ right to catalyst fees in public interest lawsuits. “Catalyst fees” are one type of attorneys’ fees designed to compensate attorney time spent on public interest lawsuits that catalyze a change in the defendant’s behavior. Not only do catalyst fees incentivize private enforcement, but they also address a specific and serious concern. Plaintiffs face the risk that defendants will vigorously litigate for months or years and then—on the eve of or during trial—fix the very problem challenged in the litigation, moot the case, and escape compensating plaintiffs for the time and effort required to call attention to the problem. In Direct Action Everywhere v. Diestel Turkey Ranch, the plaintiff encountered just this situation after it filed a false advertising lawsuit alleging that Diestel was deceiving customers about the condition in which it kept animals on its properties. Several days into the trial, Diestel voluntarily removed the allegedly false statements from its website as part of a “website refresh.” Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The trial court denied Direct Action’s motion for catalyst fees for multiple reasons, two of which stood out to the Impact Fund and its allies. First, the court scorned the plaintiff’s reason for bringing the lawsuit and, second, it criticized the plaintiff’s activities outside the courtroom. Ultimately, the court held that plaintiffs do not deserve fees when they file litigation consistent with their organizational goals or fail to behave in a manner “above reproach” before and during the litigation. Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The State Legislature and Supreme Court have defined the factors that determine whether a plaintiff is entitled to attorneys’ fees, and the trial court’s order bore little resemblance to the established analysis. If the trial court’s reasoning is allowed to stand, courts could withhold fees simply because an organizational plaintiff files mission-aligned litigation or acts in a manner that displeases them, from issuing press releases to engaging in protests or policy advocacy, regardless of whether those acts violate any law or have any effect on the litigation. This is not what the legislature or supreme court intended. California courts have long recognized that catalyst fees are key to encouraging public interest litigation, and the Impact Fund and amici continue to defend the proper catalyst fee analysis.
USER:
What is a catalyst fee?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 14 | 5 | 451 | null | 844 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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My neighbor has been adding to his property all around his home over many years, annexing land from his neighbors. What technique is he using to acquire this real estate? What's required to make this happen? How can I protect my land from his actions?
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ADVERSE POSSESSION By: George Coppolo, Chief Attorney SUMMARY Connecticut law recognizes adverse possession as a way to acquire title to property. Adverse possession is a method of acquiring title to real estate, accomplished by an open, visible, and exclusive possession uninterruptedly for a 15-year period (CGS § 52-575; Whitney v. Turmel 180 Conn. 147 (1980)). Connecticut also recognizes the right to acquire a right-of-way or other easement by continuous, uninterrupted use of someone else's land for 15 years (CGS § 47-37). The legislature has amended this law three times during the past 10 years- in 1996, 1999, and 2002. Legislation passed in 1996 authorizes a landowner who wishes to interrupt an adverse possession claim, in addition to things already required, to serve a notice on the adverse possessor and record it on the land records (PA 96-249). Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. Legislation adopted in 1999 protects land belonging to a nonprofit land-holding organization from adverse possession. The act applies to non-stock corporations whose principal purposes include the conservation and preservation of land (PA 99-64). PA 02-66 prohibits adverse possession claims on certain types of land owned by investor-owned water companies. The law in other states is similar to Connecticut's. The main difference is that some jurisdictions have established a shorter or longer period, and some have established different time periods for different types of property. CONNECTICUT Adverse possession can create an absolute title to real estate, which is as good as title by deed from the record owner. But adverse possession as record title requires evidence showing the existence of all elements necessary for adverse possession, and apparently this can be done only in a judicial proceeding to which those to be bound by the decision have been made parties. The essential elements of an adverse possession sufficient to create title to land in a claimant are that the owner is ousted of possession and kept out uninterruptedly for 15 years by an open, visible, and exclusive possession by the claimant, under a claim of right, with the intention of using the property as his own, and without the owner's consent. The possession must be hostile and under a claim of right, actual, open, notorious, exclusive, continuous, and uninterrupted (Goodman v. Quadrato, 142 Conn. 398 (1954)). The 15-year period comes from CGS § 52-575 which establishes this time frame for an owner to assert his ownership claim over an adverse possessor. A landowner who wishes to interrupt an adverse possession claim may serve a notice on the adverse possessor and record it on the land records. Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. The notice must be served on the adverse possessor, his agent, or guardian if they are in Connecticut, in the same way lawsuit papers are served. Otherwise, a copy of the notice must be affixed to the house on the land in question or to some other conspicuous part of the premises. The notice and papers indicating the notice was served must be recorded in the land records of the town where the land is located within three months after service. When the adverse possessor is unknown, the notice must be given by conspicuously posting a copy on the property, serving it on the person to whom the taxes were last assessed, and recording it on the land records. The law prohibits adverse possession of: 1. certain types of land owned by investor-owned water companies (CGS § 47-27(b)); 2. land belonging to a non-profit corporation organized under Connecticut law with land conservation or preservation as one of its principal purposes (CGS § 47-27(b)); and 3. certain railroad and canal land (CGS § 47-26).
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"================ <TEXT PASSAGE> ======= ADVERSE POSSESSION By: George Coppolo, Chief Attorney SUMMARY Connecticut law recognizes adverse possession as a way to acquire title to property. Adverse possession is a method of acquiring title to real estate, accomplished by an open, visible, and exclusive possession uninterruptedly for a 15-year period (CGS § 52-575; Whitney v. Turmel 180 Conn. 147 (1980)). Connecticut also recognizes the right to acquire a right-of-way or other easement by continuous, uninterrupted use of someone else's land for 15 years (CGS § 47-37). The legislature has amended this law three times during the past 10 years- in 1996, 1999, and 2002. Legislation passed in 1996 authorizes a landowner who wishes to interrupt an adverse possession claim, in addition to things already required, to serve a notice on the adverse possessor and record it on the land records (PA 96-249). Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. Legislation adopted in 1999 protects land belonging to a nonprofit land-holding organization from adverse possession. The act applies to non-stock corporations whose principal purposes include the conservation and preservation of land (PA 99-64). PA 02-66 prohibits adverse possession claims on certain types of land owned by investor-owned water companies. The law in other states is similar to Connecticut's. The main difference is that some jurisdictions have established a shorter or longer period, and some have established different time periods for different types of property. CONNECTICUT Adverse possession can create an absolute title to real estate, which is as good as title by deed from the record owner. But adverse possession as record title requires evidence showing the existence of all elements necessary for adverse possession, and apparently this can be done only in a judicial proceeding to which those to be bound by the decision have been made parties. The essential elements of an adverse possession sufficient to create title to land in a claimant are that the owner is ousted of possession and kept out uninterruptedly for 15 years by an open, visible, and exclusive possession by the claimant, under a claim of right, with the intention of using the property as his own, and without the owner's consent. The possession must be hostile and under a claim of right, actual, open, notorious, exclusive, continuous, and uninterrupted (Goodman v. Quadrato, 142 Conn. 398 (1954)). The 15-year period comes from CGS § 52-575 which establishes this time frame for an owner to assert his ownership claim over an adverse possessor. A landowner who wishes to interrupt an adverse possession claim may serve a notice on the adverse possessor and record it on the land records. Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. The notice must be served on the adverse possessor, his agent, or guardian if they are in Connecticut, in the same way lawsuit papers are served. Otherwise, a copy of the notice must be affixed to the house on the land in question or to some other conspicuous part of the premises. The notice and papers indicating the notice was served must be recorded in the land records of the town where the land is located within three months after service. When the adverse possessor is unknown, the notice must be given by conspicuously posting a copy on the property, serving it on the person to whom the taxes were last assessed, and recording it on the land records. The law prohibits adverse possession of: 1. certain types of land owned by investor-owned water companies (CGS § 47-27(b)); 2. land belonging to a non-profit corporation organized under Connecticut law with land conservation or preservation as one of its principal purposes (CGS § 47-27(b)); and 3. certain railroad and canal land (CGS § 47-26). https://www.cga.ct.gov/2006/rpt/2006-R-0032.htm ================ <QUESTION> ======= My neighbor has been adding to his property all around his home over many years, annexing land from his neighbors. What technique is he using to acquire this real estate? What's required to make this happen? How can I protect my land from his actions? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
ADVERSE POSSESSION By: George Coppolo, Chief Attorney SUMMARY Connecticut law recognizes adverse possession as a way to acquire title to property. Adverse possession is a method of acquiring title to real estate, accomplished by an open, visible, and exclusive possession uninterruptedly for a 15-year period (CGS § 52-575; Whitney v. Turmel 180 Conn. 147 (1980)). Connecticut also recognizes the right to acquire a right-of-way or other easement by continuous, uninterrupted use of someone else's land for 15 years (CGS § 47-37). The legislature has amended this law three times during the past 10 years- in 1996, 1999, and 2002. Legislation passed in 1996 authorizes a landowner who wishes to interrupt an adverse possession claim, in addition to things already required, to serve a notice on the adverse possessor and record it on the land records (PA 96-249). Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. Legislation adopted in 1999 protects land belonging to a nonprofit land-holding organization from adverse possession. The act applies to non-stock corporations whose principal purposes include the conservation and preservation of land (PA 99-64). PA 02-66 prohibits adverse possession claims on certain types of land owned by investor-owned water companies. The law in other states is similar to Connecticut's. The main difference is that some jurisdictions have established a shorter or longer period, and some have established different time periods for different types of property. CONNECTICUT Adverse possession can create an absolute title to real estate, which is as good as title by deed from the record owner. But adverse possession as record title requires evidence showing the existence of all elements necessary for adverse possession, and apparently this can be done only in a judicial proceeding to which those to be bound by the decision have been made parties. The essential elements of an adverse possession sufficient to create title to land in a claimant are that the owner is ousted of possession and kept out uninterruptedly for 15 years by an open, visible, and exclusive possession by the claimant, under a claim of right, with the intention of using the property as his own, and without the owner's consent. The possession must be hostile and under a claim of right, actual, open, notorious, exclusive, continuous, and uninterrupted (Goodman v. Quadrato, 142 Conn. 398 (1954)). The 15-year period comes from CGS § 52-575 which establishes this time frame for an owner to assert his ownership claim over an adverse possessor. A landowner who wishes to interrupt an adverse possession claim may serve a notice on the adverse possessor and record it on the land records. Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. The notice must be served on the adverse possessor, his agent, or guardian if they are in Connecticut, in the same way lawsuit papers are served. Otherwise, a copy of the notice must be affixed to the house on the land in question or to some other conspicuous part of the premises. The notice and papers indicating the notice was served must be recorded in the land records of the town where the land is located within three months after service. When the adverse possessor is unknown, the notice must be given by conspicuously posting a copy on the property, serving it on the person to whom the taxes were last assessed, and recording it on the land records. The law prohibits adverse possession of: 1. certain types of land owned by investor-owned water companies (CGS § 47-27(b)); 2. land belonging to a non-profit corporation organized under Connecticut law with land conservation or preservation as one of its principal purposes (CGS § 47-27(b)); and 3. certain railroad and canal land (CGS § 47-26).
USER:
My neighbor has been adding to his property all around his home over many years, annexing land from his neighbors. What technique is he using to acquire this real estate? What's required to make this happen? How can I protect my land from his actions?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 45 | 647 | null | 838 |
[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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can you summarize this text in maximum half the words it used, but with the same number of sections that the original text has. Keep the language simple and be sure to define key terms.
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1.7.0 Disentitlement Under the EI legislation, the term "disentitlement" has a specific meaning and refers to the situations described below (EI Act 6(1)). Disentitlements are imposed for something the claimant has failed to do to prove entitlement to benefits (EI Act 49(1)), for example, failed to provide information that is crucial to determining if they are entitled to benefits, failed to prove their availability for work, failed to prove they are unemployed. One or more disentitlements can be imposed concurrently, when there is more than one ground for disentitlement. 1.7.1 Effect of disentitlement Disentitlements are imposed for as little as one day, or for an indefinite period of time. In practice, a disentitlement may be imposed on any working day of the week, and continue as long as the situation that led to the disentitlement remains unchanged. If or when the claimant’s situation changes, a decision must be made as to whether the disentitlement can be terminated or rescinded completely. Benefits are not paid, or deemed to be paid, for any days of disentitlement. When a disentitlement covers a full week, it will delay the payment of benefits, and will not reduce the maximum number of weeks that could potentially be paid in the claimant’s benefit period. However, once the benefit period terminates (52 weeks plus any extensions is reached), no further benefits can be paid in that benefit period (Digest 1.4.4). This may mean that a lengthy period of disentitlement, similar to a lengthy period during which earnings are allocated, may in fact, reduce the number of weeks of benefits actually paid to a claimant (CUB 76507). 1.7.2 Grounds for disentitlement Some of the following situations automatically result in disentitlement whereas others are not specifically defined: working a full week (Digest Chapter 4) not available for work (EI Act 18(a); Digest Chapter 10) failure to prove incapacity for work in the case of sickness benefits (EI Act 18(b); EI Regulation 40) minor attachment claimant who ceased work due to incapacity (EI Act 21(1)) loss of employment or inability to resume a previous employment by reason of a labour dispute (EI Act 36); EI Regulation 52; Digest Chapter 8) confinement in a prison or similar institution (EI Act 37(a); EI Regulation 54; Digest 10.11.7) being out of Canada (EI Act 37(b); EI Regulation 55; Digest 10.11.8) non-entitlement of a teacher during the non-teaching period; (EI Regulation 33; Digest Chapter 14) delay in making a renewal or continuing claim (EI Act 50(4); EI Regulation 26(1)) failure to provide information upon request (EI Act 50(5 & 6)) suspension from employment because of misconduct (EI Act 31; Digest Chapter 7) voluntarily taking a leave from employment without just cause (EI Act 32; Digest Chapter 6) voluntarily leaving employment permanently without just cause, or losing employment by reason of their misconduct, within three weeks of termination from that employment (EI Act 33(1); Digest Chapter 6, Digest Chapter 7) not entitled to compassionate care benefits (EI Act 23.1; Digest Chapter 23) not entitled to family caregiver benefits (EI Act 23.2; EI Act 23.3; Digest Chapter 22) having received or being entitled to receive provincial benefits in respect of the birth or adoption of a child under a provincial plan (EI Regulation 76.09; Quebec Parental Insurance Plan) Each of the above grounds will be discussed in detail in subsequent chapters. 1.7.3 Length of disentitlement The legislation does not provide for a half-day disentitlement (EI Act 20). When it is determined that a disentitlement is warranted, the disentitlement must be applied for a minimum of one day. Extenuating circumstances cannot reduce a period of disentitlement; either the claimant meets the entitlement condition or they do not. The reason they may not meet it is not a factor to consider when determining if the condition is met. The start date of the disentitlement may be determined ahead of time, for example in cases where a claimant intends to be absent from Canada for vacation. However, the end of the absence may not always be known. If known, the end date of the disentitlement will be input, and the claimant is not required to contact the Commission upon return, unless there is a change to the end date. If the end date is not known, the claimant must contact the Commission upon their return, to have the end date of the disentitlement reviewed. An ongoing disentitlement may be imposed for less than five days each week. This may be the case, for example, when the disentitlement is related to the availability or capability for work of a claimant, or in the case of a labour dispute. Unless the disentitlement can be suspended, as in the case of labour dispute (Digest 8.10.0), a disentitlement continues for as long as the condition leading to the disentitlement continues to exist. However, a new ground for disentitlement requires a separate decision.
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[question] can you summarize this text in maximum half the words it used, but with the same number of sections that the original text has. Keep the language simple and be sure to define key terms. ===================== [text] 1.7.0 Disentitlement Under the EI legislation, the term "disentitlement" has a specific meaning and refers to the situations described below (EI Act 6(1)). Disentitlements are imposed for something the claimant has failed to do to prove entitlement to benefits (EI Act 49(1)), for example, failed to provide information that is crucial to determining if they are entitled to benefits, failed to prove their availability for work, failed to prove they are unemployed. One or more disentitlements can be imposed concurrently, when there is more than one ground for disentitlement. 1.7.1 Effect of disentitlement Disentitlements are imposed for as little as one day, or for an indefinite period of time. In practice, a disentitlement may be imposed on any working day of the week, and continue as long as the situation that led to the disentitlement remains unchanged. If or when the claimant’s situation changes, a decision must be made as to whether the disentitlement can be terminated or rescinded completely. Benefits are not paid, or deemed to be paid, for any days of disentitlement. When a disentitlement covers a full week, it will delay the payment of benefits, and will not reduce the maximum number of weeks that could potentially be paid in the claimant’s benefit period. However, once the benefit period terminates (52 weeks plus any extensions is reached), no further benefits can be paid in that benefit period (Digest 1.4.4). This may mean that a lengthy period of disentitlement, similar to a lengthy period during which earnings are allocated, may in fact, reduce the number of weeks of benefits actually paid to a claimant (CUB 76507). 1.7.2 Grounds for disentitlement Some of the following situations automatically result in disentitlement whereas others are not specifically defined: working a full week (Digest Chapter 4) not available for work (EI Act 18(a); Digest Chapter 10) failure to prove incapacity for work in the case of sickness benefits (EI Act 18(b); EI Regulation 40) minor attachment claimant who ceased work due to incapacity (EI Act 21(1)) loss of employment or inability to resume a previous employment by reason of a labour dispute (EI Act 36); EI Regulation 52; Digest Chapter 8) confinement in a prison or similar institution (EI Act 37(a); EI Regulation 54; Digest 10.11.7) being out of Canada (EI Act 37(b); EI Regulation 55; Digest 10.11.8) non-entitlement of a teacher during the non-teaching period; (EI Regulation 33; Digest Chapter 14) delay in making a renewal or continuing claim (EI Act 50(4); EI Regulation 26(1)) failure to provide information upon request (EI Act 50(5 & 6)) suspension from employment because of misconduct (EI Act 31; Digest Chapter 7) voluntarily taking a leave from employment without just cause (EI Act 32; Digest Chapter 6) voluntarily leaving employment permanently without just cause, or losing employment by reason of their misconduct, within three weeks of termination from that employment (EI Act 33(1); Digest Chapter 6, Digest Chapter 7) not entitled to compassionate care benefits (EI Act 23.1; Digest Chapter 23) not entitled to family caregiver benefits (EI Act 23.2; EI Act 23.3; Digest Chapter 22) having received or being entitled to receive provincial benefits in respect of the birth or adoption of a child under a provincial plan (EI Regulation 76.09; Quebec Parental Insurance Plan) Each of the above grounds will be discussed in detail in subsequent chapters. 1.7.3 Length of disentitlement The legislation does not provide for a half-day disentitlement (EI Act 20). When it is determined that a disentitlement is warranted, the disentitlement must be applied for a minimum of one day. Extenuating circumstances cannot reduce a period of disentitlement; either the claimant meets the entitlement condition or they do not. The reason they may not meet it is not a factor to consider when determining if the condition is met. The start date of the disentitlement may be determined ahead of time, for example in cases where a claimant intends to be absent from Canada for vacation. However, the end of the absence may not always be known. If known, the end date of the disentitlement will be input, and the claimant is not required to contact the Commission upon return, unless there is a change to the end date. If the end date is not known, the claimant must contact the Commission upon their return, to have the end date of the disentitlement reviewed. An ongoing disentitlement may be imposed for less than five days each week. This may be the case, for example, when the disentitlement is related to the availability or capability for work of a claimant, or in the case of a labour dispute. Unless the disentitlement can be suspended, as in the case of labour dispute (Digest 8.10.0), a disentitlement continues for as long as the condition leading to the disentitlement continues to exist. However, a new ground for disentitlement requires a separate decision. https://www.canada.ca/en/employment-social-development/programs/ei/ei-list/reports/digest/chapter-1/disentitlement.html ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
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[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
EVIDENCE:
1.7.0 Disentitlement Under the EI legislation, the term "disentitlement" has a specific meaning and refers to the situations described below (EI Act 6(1)). Disentitlements are imposed for something the claimant has failed to do to prove entitlement to benefits (EI Act 49(1)), for example, failed to provide information that is crucial to determining if they are entitled to benefits, failed to prove their availability for work, failed to prove they are unemployed. One or more disentitlements can be imposed concurrently, when there is more than one ground for disentitlement. 1.7.1 Effect of disentitlement Disentitlements are imposed for as little as one day, or for an indefinite period of time. In practice, a disentitlement may be imposed on any working day of the week, and continue as long as the situation that led to the disentitlement remains unchanged. If or when the claimant’s situation changes, a decision must be made as to whether the disentitlement can be terminated or rescinded completely. Benefits are not paid, or deemed to be paid, for any days of disentitlement. When a disentitlement covers a full week, it will delay the payment of benefits, and will not reduce the maximum number of weeks that could potentially be paid in the claimant’s benefit period. However, once the benefit period terminates (52 weeks plus any extensions is reached), no further benefits can be paid in that benefit period (Digest 1.4.4). This may mean that a lengthy period of disentitlement, similar to a lengthy period during which earnings are allocated, may in fact, reduce the number of weeks of benefits actually paid to a claimant (CUB 76507). 1.7.2 Grounds for disentitlement Some of the following situations automatically result in disentitlement whereas others are not specifically defined: working a full week (Digest Chapter 4) not available for work (EI Act 18(a); Digest Chapter 10) failure to prove incapacity for work in the case of sickness benefits (EI Act 18(b); EI Regulation 40) minor attachment claimant who ceased work due to incapacity (EI Act 21(1)) loss of employment or inability to resume a previous employment by reason of a labour dispute (EI Act 36); EI Regulation 52; Digest Chapter 8) confinement in a prison or similar institution (EI Act 37(a); EI Regulation 54; Digest 10.11.7) being out of Canada (EI Act 37(b); EI Regulation 55; Digest 10.11.8) non-entitlement of a teacher during the non-teaching period; (EI Regulation 33; Digest Chapter 14) delay in making a renewal or continuing claim (EI Act 50(4); EI Regulation 26(1)) failure to provide information upon request (EI Act 50(5 & 6)) suspension from employment because of misconduct (EI Act 31; Digest Chapter 7) voluntarily taking a leave from employment without just cause (EI Act 32; Digest Chapter 6) voluntarily leaving employment permanently without just cause, or losing employment by reason of their misconduct, within three weeks of termination from that employment (EI Act 33(1); Digest Chapter 6, Digest Chapter 7) not entitled to compassionate care benefits (EI Act 23.1; Digest Chapter 23) not entitled to family caregiver benefits (EI Act 23.2; EI Act 23.3; Digest Chapter 22) having received or being entitled to receive provincial benefits in respect of the birth or adoption of a child under a provincial plan (EI Regulation 76.09; Quebec Parental Insurance Plan) Each of the above grounds will be discussed in detail in subsequent chapters. 1.7.3 Length of disentitlement The legislation does not provide for a half-day disentitlement (EI Act 20). When it is determined that a disentitlement is warranted, the disentitlement must be applied for a minimum of one day. Extenuating circumstances cannot reduce a period of disentitlement; either the claimant meets the entitlement condition or they do not. The reason they may not meet it is not a factor to consider when determining if the condition is met. The start date of the disentitlement may be determined ahead of time, for example in cases where a claimant intends to be absent from Canada for vacation. However, the end of the absence may not always be known. If known, the end date of the disentitlement will be input, and the claimant is not required to contact the Commission upon return, unless there is a change to the end date. If the end date is not known, the claimant must contact the Commission upon their return, to have the end date of the disentitlement reviewed. An ongoing disentitlement may be imposed for less than five days each week. This may be the case, for example, when the disentitlement is related to the availability or capability for work of a claimant, or in the case of a labour dispute. Unless the disentitlement can be suspended, as in the case of labour dispute (Digest 8.10.0), a disentitlement continues for as long as the condition leading to the disentitlement continues to exist. However, a new ground for disentitlement requires a separate decision.
USER:
can you summarize this text in maximum half the words it used, but with the same number of sections that the original text has. Keep the language simple and be sure to define key terms.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 35 | 808 | null | 229 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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With Accenture and HCL, and other major ICT firms beginning to aim for sustainability, what is the position of carbon-counting tools like GreenFrame in the mitigation of emission from front-end web applications? Further, how do these companies apply 3R model(Reduce, Reuse, Recycle) in their sustainability initiatives, and what issues may ensue during the implementing strategy of these services into the ICT services?
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Studies show that carbon emissions generated by the internet, devices, and systems that support it account for 3.7% of global greenhouse gas emissions. That’s more than all aviation emissions (2.5%). It doesn’t end there. Research conducted by “Green the Web.” found that a single web page consumes on average 1.76 g CO2 per page view. As businesses, the question we need to ask ourselves is how much every click on our website/data storage/use of tech devices costs the planet. There are no specific points or steps to follow while designing a green or sustainable IT system. In truth, it’s a collection of ideas, facts, and best practices that should be followed while prioritizing sustainability principles. Climate change is an indisputable reality every organization under the sun is grappling with. Increased global warming due to rising carbon emissions is compelling both companies and customers to think about sustainability for their own future. A few statistics to understand the gravity of the current scenario: Forests being cut down: Since 2016, an average of 28 million hectares have been cut down every year. Half of the world’s rainforest has been destroyed in just one century. Nearly 2.7 billion tons of coal mined globally to date: Strip mining accounts for 40% of the world’s coal mines and the practice destroys landscapes, forests, and wildlife habitation. The global Information Communication Technology (ICT) industry contributes 2%-3% of greenhouse gas (GHG) emissions: User devices, networks, and data centers hold the largest share of carbon emissions compared to other contributors within the ICT industry. Related reading: The growth of green consumerism: Shaping sustainable futures “Sustainability” – the real buzz around the entire ICT industry Environmental, Social, and Governance (ESG) investors are using non-financial aspects more often as part of their analytical process to assess opportunities and identify material risks. ESG investors have become a growing force in capital markets and poured around $649 Bn into ESG funds in 2021. The US has experienced the highest growth in recent years and may come to dominate the category starting in 2022. ECG-mandated & non-mandated assets Shifts in design globally and the role of IT companies Green or sustainable IT is bringing about a transformative change in the users’ mindset. Right from the efficient utilization of resources, reduction in waste, innovative and sustainable design approach, low power devices, and more, ICT companies can immensely contribute towards this objective of global environmental sustainability. Global IT industry leaders like Accenture, Microsoft, IBM, HCL, Oracle, etc., are working towards IT sustainability and incorporating a sustainable approach in their products and services. There are tools available to measure CO2 emissions in front-end web applications (E.g. Wholegrain Digital and GreenFrame). However, for native/mobile applications currently, a few startups are working to measure CO2 emissions. Some of the names include Pangolin, CoGo, and ImpactVision. Increasing use of 3D arts, electronics wearables, mobile apps, NFTs, gamification, IoT devices, and data centers have raised serious concerns for designers and developers about incurring sustainability issues and reducing carbon footprints. Savvy startups eager to prove their concern are already working towards providing sustainability in their product/services. Current innovation in and sustainability R&D concept in the IT industry are being developed and applied to future paradigm parameters like the generation of extremely consistent recycling management approaches for hardware and batteries. Importance of 3 Rs in sustainable IT: reusing, recycling, reducing The entire environmental sustainability revolves around 3 Rs (reusing, recycling, reducing). IT enterprises (more likely hardware companies) can create advanced IT systems keeping these 3 Rs in mind. Recycling is using old components or parts in a new way or using waste as resources. Reusing refers to the repeated use of items or parts of items which still have usable aspects including network interfaces and communication devices. Reducing means optimizing the amount of waste or energy consumed with means of choosing things with care to reduce the amount of waste generated. Optimized customer experiences are turning into game-changers and IT technology trends are focused on this digital-savvy generation. The necessity to get on the sustainable IT trends wave Before discussing sustainable IT trends, let’s start with why it is imperative to catch up with these trends: Competitive edge: Staying informed on the latest trends of sustainability and monitoring how your competitors are treating their customers helps you drive competitive uniqueness. New customer acquisition: Consumers have begun to change their buying patterns due to the shift to digital platforms, products, and services. Considering sustainability (low power, fast charging, and compact designs) as the primary go-to-market strategy allows enterprises to tap into new ways to acquire customers. Customer retention: Customer loyalty is an irreplaceable asset. By offering your customers the experience they deserve, enterprises can build a connection that goes beyond a single interaction or purchase. Sustainability will remain a top priority for ICT brands to survive and thrive. A few key trends we think will help your customers and the market at large take note of your sustainable approach now and into the future: ICT initiative that lifts sustainability Ensuring these ideas are embedded into hardware and software designs will not only lead to improved performance and usability. It will also ensure quality of product or services that company offers. As leading ICT brands like Microsoft, Intel, Google, AT&T, AWS, etc. need to implement a sustainability approach to build a green future, accessible to all. Creating a simpler, smoother online experience can also help reduce visitor screen time and webpage bandwidth usage. As a part of sustainable product/service design, savvy companies are already working to support the environment by compact designs, use of advanced technologies like AI and ML, and incorporate energy efficient systems. Going green is a core part of doing business today for any enterprise. Sustainable/green approach results in a win-win-win situation for the economy, society, and environment. Enterprises operating in ICT sector must consider sustainability as their responsibility while developing new technologies, products, and services.
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"================ <TEXT PASSAGE> ======= Studies show that carbon emissions generated by the internet, devices, and systems that support it account for 3.7% of global greenhouse gas emissions. That’s more than all aviation emissions (2.5%). It doesn’t end there. Research conducted by “Green the Web.” found that a single web page consumes on average 1.76 g CO2 per page view. As businesses, the question we need to ask ourselves is how much every click on our website/data storage/use of tech devices costs the planet. There are no specific points or steps to follow while designing a green or sustainable IT system. In truth, it’s a collection of ideas, facts, and best practices that should be followed while prioritizing sustainability principles. Climate change is an indisputable reality every organization under the sun is grappling with. Increased global warming due to rising carbon emissions is compelling both companies and customers to think about sustainability for their own future. A few statistics to understand the gravity of the current scenario: Forests being cut down: Since 2016, an average of 28 million hectares have been cut down every year. Half of the world’s rainforest has been destroyed in just one century. Nearly 2.7 billion tons of coal mined globally to date: Strip mining accounts for 40% of the world’s coal mines and the practice destroys landscapes, forests, and wildlife habitation. The global Information Communication Technology (ICT) industry contributes 2%-3% of greenhouse gas (GHG) emissions: User devices, networks, and data centers hold the largest share of carbon emissions compared to other contributors within the ICT industry. Related reading: The growth of green consumerism: Shaping sustainable futures “Sustainability” – the real buzz around the entire ICT industry Environmental, Social, and Governance (ESG) investors are using non-financial aspects more often as part of their analytical process to assess opportunities and identify material risks. ESG investors have become a growing force in capital markets and poured around $649 Bn into ESG funds in 2021. The US has experienced the highest growth in recent years and may come to dominate the category starting in 2022. ECG-mandated & non-mandated assets Shifts in design globally and the role of IT companies Green or sustainable IT is bringing about a transformative change in the users’ mindset. Right from the efficient utilization of resources, reduction in waste, innovative and sustainable design approach, low power devices, and more, ICT companies can immensely contribute towards this objective of global environmental sustainability. Global IT industry leaders like Accenture, Microsoft, IBM, HCL, Oracle, etc., are working towards IT sustainability and incorporating a sustainable approach in their products and services. There are tools available to measure CO2 emissions in front-end web applications (E.g. Wholegrain Digital and GreenFrame). However, for native/mobile applications currently, a few startups are working to measure CO2 emissions. Some of the names include Pangolin, CoGo, and ImpactVision. Increasing use of 3D arts, electronics wearables, mobile apps, NFTs, gamification, IoT devices, and data centers have raised serious concerns for designers and developers about incurring sustainability issues and reducing carbon footprints. Savvy startups eager to prove their concern are already working towards providing sustainability in their product/services. Current innovation in and sustainability R&D concept in the IT industry are being developed and applied to future paradigm parameters like the generation of extremely consistent recycling management approaches for hardware and batteries. Importance of 3 Rs in sustainable IT: reusing, recycling, reducing The entire environmental sustainability revolves around 3 Rs (reusing, recycling, reducing). IT enterprises (more likely hardware companies) can create advanced IT systems keeping these 3 Rs in mind. Recycling is using old components or parts in a new way or using waste as resources. Reusing refers to the repeated use of items or parts of items which still have usable aspects including network interfaces and communication devices. Reducing means optimizing the amount of waste or energy consumed with means of choosing things with care to reduce the amount of waste generated. Optimized customer experiences are turning into game-changers and IT technology trends are focused on this digital-savvy generation. The necessity to get on the sustainable IT trends wave Before discussing sustainable IT trends, let’s start with why it is imperative to catch up with these trends: Competitive edge: Staying informed on the latest trends of sustainability and monitoring how your competitors are treating their customers helps you drive competitive uniqueness. New customer acquisition: Consumers have begun to change their buying patterns due to the shift to digital platforms, products, and services. Considering sustainability (low power, fast charging, and compact designs) as the primary go-to-market strategy allows enterprises to tap into new ways to acquire customers. Customer retention: Customer loyalty is an irreplaceable asset. By offering your customers the experience they deserve, enterprises can build a connection that goes beyond a single interaction or purchase. Sustainability will remain a top priority for ICT brands to survive and thrive. A few key trends we think will help your customers and the market at large take note of your sustainable approach now and into the future: ICT initiative that lifts sustainability Ensuring these ideas are embedded into hardware and software designs will not only lead to improved performance and usability. It will also ensure quality of product or services that company offers. As leading ICT brands like Microsoft, Intel, Google, AT&T, AWS, etc. need to implement a sustainability approach to build a green future, accessible to all. Creating a simpler, smoother online experience can also help reduce visitor screen time and webpage bandwidth usage. As a part of sustainable product/service design, savvy companies are already working to support the environment by compact designs, use of advanced technologies like AI and ML, and incorporate energy efficient systems. Going green is a core part of doing business today for any enterprise. Sustainable/green approach results in a win-win-win situation for the economy, society, and environment. Enterprises operating in ICT sector must consider sustainability as their responsibility while developing new technologies, products, and services. https://www.netscribes.com/sustainable-it-reducing-carbon-footprints-and-preserving-resources/ ================ <QUESTION> ======= With Accenture and HCL, and other major ICT firms beginning to aim for sustainability, what is the position of carbon-counting tools like GreenFrame in the mitigation of emission from front-end web applications? Further, how do these companies apply 3R model(Reduce, Reuse, Recycle) in their sustainability initiatives, and what issues may ensue during the implementing strategy of these services into the ICT services? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
|
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
Studies show that carbon emissions generated by the internet, devices, and systems that support it account for 3.7% of global greenhouse gas emissions. That’s more than all aviation emissions (2.5%). It doesn’t end there. Research conducted by “Green the Web.” found that a single web page consumes on average 1.76 g CO2 per page view. As businesses, the question we need to ask ourselves is how much every click on our website/data storage/use of tech devices costs the planet. There are no specific points or steps to follow while designing a green or sustainable IT system. In truth, it’s a collection of ideas, facts, and best practices that should be followed while prioritizing sustainability principles. Climate change is an indisputable reality every organization under the sun is grappling with. Increased global warming due to rising carbon emissions is compelling both companies and customers to think about sustainability for their own future. A few statistics to understand the gravity of the current scenario: Forests being cut down: Since 2016, an average of 28 million hectares have been cut down every year. Half of the world’s rainforest has been destroyed in just one century. Nearly 2.7 billion tons of coal mined globally to date: Strip mining accounts for 40% of the world’s coal mines and the practice destroys landscapes, forests, and wildlife habitation. The global Information Communication Technology (ICT) industry contributes 2%-3% of greenhouse gas (GHG) emissions: User devices, networks, and data centers hold the largest share of carbon emissions compared to other contributors within the ICT industry. Related reading: The growth of green consumerism: Shaping sustainable futures “Sustainability” – the real buzz around the entire ICT industry Environmental, Social, and Governance (ESG) investors are using non-financial aspects more often as part of their analytical process to assess opportunities and identify material risks. ESG investors have become a growing force in capital markets and poured around $649 Bn into ESG funds in 2021. The US has experienced the highest growth in recent years and may come to dominate the category starting in 2022. ECG-mandated & non-mandated assets Shifts in design globally and the role of IT companies Green or sustainable IT is bringing about a transformative change in the users’ mindset. Right from the efficient utilization of resources, reduction in waste, innovative and sustainable design approach, low power devices, and more, ICT companies can immensely contribute towards this objective of global environmental sustainability. Global IT industry leaders like Accenture, Microsoft, IBM, HCL, Oracle, etc., are working towards IT sustainability and incorporating a sustainable approach in their products and services. There are tools available to measure CO2 emissions in front-end web applications (E.g. Wholegrain Digital and GreenFrame). However, for native/mobile applications currently, a few startups are working to measure CO2 emissions. Some of the names include Pangolin, CoGo, and ImpactVision. Increasing use of 3D arts, electronics wearables, mobile apps, NFTs, gamification, IoT devices, and data centers have raised serious concerns for designers and developers about incurring sustainability issues and reducing carbon footprints. Savvy startups eager to prove their concern are already working towards providing sustainability in their product/services. Current innovation in and sustainability R&D concept in the IT industry are being developed and applied to future paradigm parameters like the generation of extremely consistent recycling management approaches for hardware and batteries. Importance of 3 Rs in sustainable IT: reusing, recycling, reducing The entire environmental sustainability revolves around 3 Rs (reusing, recycling, reducing). IT enterprises (more likely hardware companies) can create advanced IT systems keeping these 3 Rs in mind. Recycling is using old components or parts in a new way or using waste as resources. Reusing refers to the repeated use of items or parts of items which still have usable aspects including network interfaces and communication devices. Reducing means optimizing the amount of waste or energy consumed with means of choosing things with care to reduce the amount of waste generated. Optimized customer experiences are turning into game-changers and IT technology trends are focused on this digital-savvy generation. The necessity to get on the sustainable IT trends wave Before discussing sustainable IT trends, let’s start with why it is imperative to catch up with these trends: Competitive edge: Staying informed on the latest trends of sustainability and monitoring how your competitors are treating their customers helps you drive competitive uniqueness. New customer acquisition: Consumers have begun to change their buying patterns due to the shift to digital platforms, products, and services. Considering sustainability (low power, fast charging, and compact designs) as the primary go-to-market strategy allows enterprises to tap into new ways to acquire customers. Customer retention: Customer loyalty is an irreplaceable asset. By offering your customers the experience they deserve, enterprises can build a connection that goes beyond a single interaction or purchase. Sustainability will remain a top priority for ICT brands to survive and thrive. A few key trends we think will help your customers and the market at large take note of your sustainable approach now and into the future: ICT initiative that lifts sustainability Ensuring these ideas are embedded into hardware and software designs will not only lead to improved performance and usability. It will also ensure quality of product or services that company offers. As leading ICT brands like Microsoft, Intel, Google, AT&T, AWS, etc. need to implement a sustainability approach to build a green future, accessible to all. Creating a simpler, smoother online experience can also help reduce visitor screen time and webpage bandwidth usage. As a part of sustainable product/service design, savvy companies are already working to support the environment by compact designs, use of advanced technologies like AI and ML, and incorporate energy efficient systems. Going green is a core part of doing business today for any enterprise. Sustainable/green approach results in a win-win-win situation for the economy, society, and environment. Enterprises operating in ICT sector must consider sustainability as their responsibility while developing new technologies, products, and services.
USER:
With Accenture and HCL, and other major ICT firms beginning to aim for sustainability, what is the position of carbon-counting tools like GreenFrame in the mitigation of emission from front-end web applications? Further, how do these companies apply 3R model(Reduce, Reuse, Recycle) in their sustainability initiatives, and what issues may ensue during the implementing strategy of these services into the ICT services?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 62 | 985 | null | 353 |
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
|
My son wants to start playing football but I'm scared he will get a concussion. Can you help me to understand what concussions actually are? How does it affect a growing child?
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According to a recent Harris Poll, football continues its long reign as America’s most popular sport. From pre-game tailgating to the actual event, where any team can win any week, to post-game celebration parties, and of course, the Super Bowl – one of the most-watched television programs in the country – what’s not to love? Yet despite its popularity, there is increasing concern and controversy about the long-term safety of playing football, which has resulted in many parents deciding not to allow their kids to participate in the game. In fact, a recent Bloomberg Politics poll found that half of all Americans say they wouldn’t want their child to play football. The biggest concern? Head injury. According to HealthResearchFunding.org, concussion rates for children under age 19 who play tackle football have doubled over the last decade, most occurring during practices. Concussions can occur with a blow to the head through helmet to helmet contact, and if undiagnosed and left untreated can lead to permanent brain damage. What is more, “subconcussive hits,” or repeated blows to the head that don’t result in concussions can, over a long period of time, have long term health effects, too – primarily chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma. CTE caused by repetitive blows to the head as a result of playing football was brought to light in 2002 by Bennet Omalu, a Nigerian-American physician and forensic pathologist, who discovered the condition during an autopsy of former Pittsburgh Steelers player Mike Webster. This finding, as well as his subsequent reports of CTE in other deceased NFL players, eventually led to the book and later the 2015 film, “Concussion.” It also spurred increasing concern about whether children should be playing football at all. If you were to ask Omalu, the answer would be no. In a 2015 “The New York Times” editorial piece he wrote: “If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name chronic traumatic encephalopathy…” But many sports medicine physicians, like Kristin Ernest, MD, who practices at Texas Children’s Hospital the Woodlands, are less adamant about banning youth tackle football. “There is no conclusive evidence that shows us children shouldn’t play football,” she claimed. “But they should be taught proper technique, and they should have proper fitting equipment.” Jonathan Minor, MD, a pediatric sports medicine specialist on the concussion management team at CHOC hospital in California, agreed that we don’t know whether there’s a cumulative effect of head injury in football beginning in childhood. But he does believe that such injuries may be prevented by introducing kids first to non-impact football, allowing them to develop skills before playing the contact game. He also advocates core strengthening exercises as a part of football practice. “There is some research showing that core and neck strengthening can help to prevent traumatic brain injury during football,” he said. And the American Academy of Pediatrics (AAP), while endorsing efforts to limit contact practices in youth football, recently refused to support those calling for an outright ban on tackling in football for athletes below age 18, saying that it is unwilling to recommend such a fundamental change in the way the game is played. The bottom line is that it’s up to parents to decide whether the risks of youth tackle football outweigh the recreational benefit. Some things to consider for kids who do play football: Learn the youth concussion laws in your state. While all states now have laws designed to reduce risk of concussion and other head injuries in youth football, not all state laws are equal, according to USA Football. Fewer than half contain all of the key principles, such as limits on full contact practice, mandatory education about concussion symptoms for coaches, removal of a player from the game if a head injury is suspected, and written medical clearance for return to play. Only a handful of laws specify which ages/grades are covered and whether the law pertains to public and private schools and athletic leagues. Worse yet, almost all lack consequences for schools or leagues that don’t comply with the law. Find your state laws on USAFootball.com and make sure they are being followed. Make sure your child is being taught “heads up” tackle technique, advised Dr. Ernest. This USA-designed program utilizes five fundamentals through a series of drills to reinforce proper tackling mechanics and teaches players to focus on reducing helmet contact. Research presented at the American Academy of Pediatrics’ recent meeting in Washington D.C. showed that limits on full-contact practice as well as teaching Heads Up tackling are working to reduce concussion risk in youth football. Consider a baseline neurocognitive test, such as ImPACT testing, for your child prior to the football season, even if it’s not required by your child’s coach, said Dr. Minor. “A neurocognitive test is a computer-based 20-30 minute test that measures brain functions like visual and verbal memory and reaction time,” he explained. “It’s very helpful to do at the beginning of the season and then repeat if there are signs of concussion. It can help, along with medical evaluation, to make a diagnosis.” Make sure your child is fitted properly with protective equipment and wears it all the time. Know the symptoms of concussion – and make sure your child knows them, too. He should know that it’s important to report any of these symptoms to the coach and to you and that he should be removed from the practice or game immediately. A child who is suspected to have a concussion should see a licensed health professional as soon as possible. Follow the doctor’s orders exactly if your child has a concussion, said Dr. Ernest. Failure to follow orders for physical and cognitive rest can prolong recovery. And know that those who have a first concussion are 3-6 times more likely to suffer another concussion than an athlete who has not had a concussion. So returning to play before the brain has fully healed can put your athlete at higher risk for complications if a second concussion is sustained. WHAT YOU SHOULD KNOW ABOUT CONCUSSIONS WHAT IT IS: According to sports medicine physician Kristin Ernest, MD, a concussion is any force transmitted to the brain itself. While it generally occurs with a blow to the head, any injury that causes the brain to shift rapidly within the skull (such as a whiplash injury) can cause a concussion. SYMPTOMS OF CONCUSSION: While symptoms can vary from child to child, said Dr. Ernest, some of the most common are headache, nausea, dizziness, irritability or crying, trouble concentrating, and sleep disturbance (sleeping more or less than usual). HOW IT’S DIAGNOSED: A concussion will not show up on imaging tests, such as MRI, said Dr. Ernest. It is diagnosed through medical evaluation of symptoms and often, neurocognitive testing. HOW CONCUSSIONS ARE TREATED: Concussions are treated with both physical and cognitive rest, according to Dr. Ernest. This includes rest from all athletic activities, as well as from homework and screen time. In general, recovery takes about 7-10 days, longer for younger children and for those with a history of migraine or ADHD. MS&F
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> My son wants to start playing football but I'm scared he will get a concussion. Can you help me to understand what concussions actually are? How does it affect a growing child? <TEXT> According to a recent Harris Poll, football continues its long reign as America’s most popular sport. From pre-game tailgating to the actual event, where any team can win any week, to post-game celebration parties, and of course, the Super Bowl – one of the most-watched television programs in the country – what’s not to love? Yet despite its popularity, there is increasing concern and controversy about the long-term safety of playing football, which has resulted in many parents deciding not to allow their kids to participate in the game. In fact, a recent Bloomberg Politics poll found that half of all Americans say they wouldn’t want their child to play football. The biggest concern? Head injury. According to HealthResearchFunding.org, concussion rates for children under age 19 who play tackle football have doubled over the last decade, most occurring during practices. Concussions can occur with a blow to the head through helmet to helmet contact, and if undiagnosed and left untreated can lead to permanent brain damage. What is more, “subconcussive hits,” or repeated blows to the head that don’t result in concussions can, over a long period of time, have long term health effects, too – primarily chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma. CTE caused by repetitive blows to the head as a result of playing football was brought to light in 2002 by Bennet Omalu, a Nigerian-American physician and forensic pathologist, who discovered the condition during an autopsy of former Pittsburgh Steelers player Mike Webster. This finding, as well as his subsequent reports of CTE in other deceased NFL players, eventually led to the book and later the 2015 film, “Concussion.” It also spurred increasing concern about whether children should be playing football at all. If you were to ask Omalu, the answer would be no. In a 2015 “The New York Times” editorial piece he wrote: “If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name chronic traumatic encephalopathy…” But many sports medicine physicians, like Kristin Ernest, MD, who practices at Texas Children’s Hospital the Woodlands, are less adamant about banning youth tackle football. “There is no conclusive evidence that shows us children shouldn’t play football,” she claimed. “But they should be taught proper technique, and they should have proper fitting equipment.” Jonathan Minor, MD, a pediatric sports medicine specialist on the concussion management team at CHOC hospital in California, agreed that we don’t know whether there’s a cumulative effect of head injury in football beginning in childhood. But he does believe that such injuries may be prevented by introducing kids first to non-impact football, allowing them to develop skills before playing the contact game. He also advocates core strengthening exercises as a part of football practice. “There is some research showing that core and neck strengthening can help to prevent traumatic brain injury during football,” he said. And the American Academy of Pediatrics (AAP), while endorsing efforts to limit contact practices in youth football, recently refused to support those calling for an outright ban on tackling in football for athletes below age 18, saying that it is unwilling to recommend such a fundamental change in the way the game is played. The bottom line is that it’s up to parents to decide whether the risks of youth tackle football outweigh the recreational benefit. Some things to consider for kids who do play football: Learn the youth concussion laws in your state. While all states now have laws designed to reduce risk of concussion and other head injuries in youth football, not all state laws are equal, according to USA Football. Fewer than half contain all of the key principles, such as limits on full contact practice, mandatory education about concussion symptoms for coaches, removal of a player from the game if a head injury is suspected, and written medical clearance for return to play. Only a handful of laws specify which ages/grades are covered and whether the law pertains to public and private schools and athletic leagues. Worse yet, almost all lack consequences for schools or leagues that don’t comply with the law. Find your state laws on USAFootball.com and make sure they are being followed. Make sure your child is being taught “heads up” tackle technique, advised Dr. Ernest. This USA-designed program utilizes five fundamentals through a series of drills to reinforce proper tackling mechanics and teaches players to focus on reducing helmet contact. Research presented at the American Academy of Pediatrics’ recent meeting in Washington D.C. showed that limits on full-contact practice as well as teaching Heads Up tackling are working to reduce concussion risk in youth football. Consider a baseline neurocognitive test, such as ImPACT testing, for your child prior to the football season, even if it’s not required by your child’s coach, said Dr. Minor. “A neurocognitive test is a computer-based 20-30 minute test that measures brain functions like visual and verbal memory and reaction time,” he explained. “It’s very helpful to do at the beginning of the season and then repeat if there are signs of concussion. It can help, along with medical evaluation, to make a diagnosis.” Make sure your child is fitted properly with protective equipment and wears it all the time. Know the symptoms of concussion – and make sure your child knows them, too. He should know that it’s important to report any of these symptoms to the coach and to you and that he should be removed from the practice or game immediately. A child who is suspected to have a concussion should see a licensed health professional as soon as possible. Follow the doctor’s orders exactly if your child has a concussion, said Dr. Ernest. Failure to follow orders for physical and cognitive rest can prolong recovery. And know that those who have a first concussion are 3-6 times more likely to suffer another concussion than an athlete who has not had a concussion. So returning to play before the brain has fully healed can put your athlete at higher risk for complications if a second concussion is sustained. WHAT YOU SHOULD KNOW ABOUT CONCUSSIONS WHAT IT IS: According to sports medicine physician Kristin Ernest, MD, a concussion is any force transmitted to the brain itself. While it generally occurs with a blow to the head, any injury that causes the brain to shift rapidly within the skull (such as a whiplash injury) can cause a concussion. SYMPTOMS OF CONCUSSION: While symptoms can vary from child to child, said Dr. Ernest, some of the most common are headache, nausea, dizziness, irritability or crying, trouble concentrating, and sleep disturbance (sleeping more or less than usual). HOW IT’S DIAGNOSED: A concussion will not show up on imaging tests, such as MRI, said Dr. Ernest. It is diagnosed through medical evaluation of symptoms and often, neurocognitive testing. HOW CONCUSSIONS ARE TREATED: Concussions are treated with both physical and cognitive rest, according to Dr. Ernest. This includes rest from all athletic activities, as well as from homework and screen time. In general, recovery takes about 7-10 days, longer for younger children and for those with a history of migraine or ADHD. MS&F https://choc.org/news/football-concussion-worth-risk/
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
According to a recent Harris Poll, football continues its long reign as America’s most popular sport. From pre-game tailgating to the actual event, where any team can win any week, to post-game celebration parties, and of course, the Super Bowl – one of the most-watched television programs in the country – what’s not to love? Yet despite its popularity, there is increasing concern and controversy about the long-term safety of playing football, which has resulted in many parents deciding not to allow their kids to participate in the game. In fact, a recent Bloomberg Politics poll found that half of all Americans say they wouldn’t want their child to play football. The biggest concern? Head injury. According to HealthResearchFunding.org, concussion rates for children under age 19 who play tackle football have doubled over the last decade, most occurring during practices. Concussions can occur with a blow to the head through helmet to helmet contact, and if undiagnosed and left untreated can lead to permanent brain damage. What is more, “subconcussive hits,” or repeated blows to the head that don’t result in concussions can, over a long period of time, have long term health effects, too – primarily chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma. CTE caused by repetitive blows to the head as a result of playing football was brought to light in 2002 by Bennet Omalu, a Nigerian-American physician and forensic pathologist, who discovered the condition during an autopsy of former Pittsburgh Steelers player Mike Webster. This finding, as well as his subsequent reports of CTE in other deceased NFL players, eventually led to the book and later the 2015 film, “Concussion.” It also spurred increasing concern about whether children should be playing football at all. If you were to ask Omalu, the answer would be no. In a 2015 “The New York Times” editorial piece he wrote: “If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name chronic traumatic encephalopathy…” But many sports medicine physicians, like Kristin Ernest, MD, who practices at Texas Children’s Hospital the Woodlands, are less adamant about banning youth tackle football. “There is no conclusive evidence that shows us children shouldn’t play football,” she claimed. “But they should be taught proper technique, and they should have proper fitting equipment.” Jonathan Minor, MD, a pediatric sports medicine specialist on the concussion management team at CHOC hospital in California, agreed that we don’t know whether there’s a cumulative effect of head injury in football beginning in childhood. But he does believe that such injuries may be prevented by introducing kids first to non-impact football, allowing them to develop skills before playing the contact game. He also advocates core strengthening exercises as a part of football practice. “There is some research showing that core and neck strengthening can help to prevent traumatic brain injury during football,” he said. And the American Academy of Pediatrics (AAP), while endorsing efforts to limit contact practices in youth football, recently refused to support those calling for an outright ban on tackling in football for athletes below age 18, saying that it is unwilling to recommend such a fundamental change in the way the game is played. The bottom line is that it’s up to parents to decide whether the risks of youth tackle football outweigh the recreational benefit. Some things to consider for kids who do play football: Learn the youth concussion laws in your state. While all states now have laws designed to reduce risk of concussion and other head injuries in youth football, not all state laws are equal, according to USA Football. Fewer than half contain all of the key principles, such as limits on full contact practice, mandatory education about concussion symptoms for coaches, removal of a player from the game if a head injury is suspected, and written medical clearance for return to play. Only a handful of laws specify which ages/grades are covered and whether the law pertains to public and private schools and athletic leagues. Worse yet, almost all lack consequences for schools or leagues that don’t comply with the law. Find your state laws on USAFootball.com and make sure they are being followed. Make sure your child is being taught “heads up” tackle technique, advised Dr. Ernest. This USA-designed program utilizes five fundamentals through a series of drills to reinforce proper tackling mechanics and teaches players to focus on reducing helmet contact. Research presented at the American Academy of Pediatrics’ recent meeting in Washington D.C. showed that limits on full-contact practice as well as teaching Heads Up tackling are working to reduce concussion risk in youth football. Consider a baseline neurocognitive test, such as ImPACT testing, for your child prior to the football season, even if it’s not required by your child’s coach, said Dr. Minor. “A neurocognitive test is a computer-based 20-30 minute test that measures brain functions like visual and verbal memory and reaction time,” he explained. “It’s very helpful to do at the beginning of the season and then repeat if there are signs of concussion. It can help, along with medical evaluation, to make a diagnosis.” Make sure your child is fitted properly with protective equipment and wears it all the time. Know the symptoms of concussion – and make sure your child knows them, too. He should know that it’s important to report any of these symptoms to the coach and to you and that he should be removed from the practice or game immediately. A child who is suspected to have a concussion should see a licensed health professional as soon as possible. Follow the doctor’s orders exactly if your child has a concussion, said Dr. Ernest. Failure to follow orders for physical and cognitive rest can prolong recovery. And know that those who have a first concussion are 3-6 times more likely to suffer another concussion than an athlete who has not had a concussion. So returning to play before the brain has fully healed can put your athlete at higher risk for complications if a second concussion is sustained. WHAT YOU SHOULD KNOW ABOUT CONCUSSIONS WHAT IT IS: According to sports medicine physician Kristin Ernest, MD, a concussion is any force transmitted to the brain itself. While it generally occurs with a blow to the head, any injury that causes the brain to shift rapidly within the skull (such as a whiplash injury) can cause a concussion. SYMPTOMS OF CONCUSSION: While symptoms can vary from child to child, said Dr. Ernest, some of the most common are headache, nausea, dizziness, irritability or crying, trouble concentrating, and sleep disturbance (sleeping more or less than usual). HOW IT’S DIAGNOSED: A concussion will not show up on imaging tests, such as MRI, said Dr. Ernest. It is diagnosed through medical evaluation of symptoms and often, neurocognitive testing. HOW CONCUSSIONS ARE TREATED: Concussions are treated with both physical and cognitive rest, according to Dr. Ernest. This includes rest from all athletic activities, as well as from homework and screen time. In general, recovery takes about 7-10 days, longer for younger children and for those with a history of migraine or ADHD. MS&F
USER:
My son wants to start playing football but I'm scared he will get a concussion. Can you help me to understand what concussions actually are? How does it affect a growing child?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 32 | 1,261 | null | 607 |
You are required to answer questions based solely on the information provided in the prompt. You will not use any outside resources or internal knowledge.
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What are the risks associated with high interest rates on mortgages?
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Mortgage Classifications Mortgages can be classified into several categories based on their characteristics. The broadest distinction is between government-insured mortgages and conventional mortgages. Government- insured mortgages have mortgage insurance from a government agency, such as FHA, VA, or USDA, whereas conventional mortgages do not have government insurance. As previously noted, this insurance pays the lender if the borrower defaults. Borrowers can also be classified into two broad groups based on their credit history: prime and non-prime. Although there is no single agreed-upon definition, prime borrowers generally have very good credit and are offered more attractive mortgage terms, such as better interest rates, than non-prime borrowers. Non-prime borrowers exhibit one or more factors that make them appear riskier to lenders, such as past credit problems or a lack of complete income and asset documentation. Conventional mortgages can be broken down into two additional groups, conforming and nonconforming mortgages. Conforming loans are loans eligible to be purchased in the secondary market by Fannie Mae and Freddie Mac, two GSEs that are discussed later in this report. To be a conforming loan, the mortgage must meet certain creditworthiness thresholds (such as a minimum credit score) and be less than the “conforming loan limit,” a legal cap on the principal balance of the mortgage that can vary based on the geographic area where the house is located.18 Borrowers with conforming loans are usually prime borrowers. Nonconforming loans can be broken down into three additional categories depending on the reason they are not conforming. First, nonconforming loans above the conforming loan limit are called jumbo loans.19 Second, Alt-A loans are for near-prime borrowers who may have credit problems or who do not have complete documentation for income or assets. Third, subprime loans are generally for the riskiest borrowers; they either have low credit scores, documentation issues, or some other factor that makes them appear to be riskier to lenders. Subprime borrowers are likely to be charged a higher interest rate to compensate the lender for the additional risk.20 Risks Associated with Holding Mortgages When a lender originates a mortgage, it accepts certain risks. The three major risks are credit, prepayment, and funding risk. Credit risk refers to the risk that the lender bears if a borrower does not repay the mortgage on time. 21 Prepayment risk is the risk that a mortgage will be paid off sooner than expected, typically by a borrower refinancing the mortgage or selling the home. This is more likely to happen when interest rates fall, because borrowers are more likely to refinance their mortgages to take advantage of lower interest rates. 22 When a borrower refinances, the lender is paid in full the amount owed, but it now has to reinvest those funds at a time when its expected return on new investments is lower because interest rates have fallen. Although prepayment risk is a risk associated with falling interest rates, there are also risks for lenders that come from rising interest rates. One of these risks, called funding risk, arises because some lenders borrow money in the short term to fund long-term investments, such as 30-year mortgages. Short-term interest rates are typically lower than long-term interest rates because of the additional risk associated with lending money for a longer period of time. Lenders, therefore, can profit from the difference, or spread, between the short-term and long-term rates. If interest rates rise, then the lender will have to borrow funds at a higher interest rate, while still earning the same interest rate on the mortgage. As long as the short-term rate stays below the long-term return, the lender would profit on the difference, although its profits would be lower than if the short-term interest rates had not increased. If short-term rates increase above the fixed return on the mortgage, then the investment would no longer be profitable. Another lender’s risk associated with rising interest rates is opportunity costs. If interest rates rise, but lender’s money is tied up in long-term mortgages made at lower interest rates, then the lender is missing out on higher returns that it could be earning if it were able to originate mortgages or make other investments at the higher current interest rate. The lender that originates a mortgage does not necessarily have to bear all of the associated risks. In some cases, the borrower could bear some of these risks. Adjustable-rate mortgages, for example, transfer the risk that interest rates might rise from the lender to the borrower. Lenders can also sell mortgages to investors, who then bear the risks associated with the mortgage. The market for buying and selling mortgages is called the secondary market, which is described below. The Secondary Market After a lender originates a mortgage loan, the lender has several options. The lender could choose to hold the mortgage in its portfolio or sell it to another entity. Mortgages are bought and sold in the secondary market to domestic and international investors. When a mortgage is sold, the mortgage servicer may change. In any case, the borrower continues to send monthly mortgage payments to the mortgage servicer.23 The servicer remits the payments to the entity that purchased the mortgage. The secondary market plays an important role in providing funding for loans made in the primary market. When a mortgage is sold in the secondary market, the lender can use the proceeds to fund additional new mortgages in the primary market. If the lender holds the mortgage in its portfolio, the lender has fewer available funds to make new mortgages. Furthermore, selling the loan to another entity allows the lender to transfer mortgage lending risks to the buyer. Securitization When a lender sells a mortgage in the secondary market, the new mortgage holder can hold the mortgage as a whole loan. When held as a whole loan, the mortgage is in the portfolio of the new mortgage holder, and the new mortgage holder bears the risks associated with the mortgage. Alternatively, the new mortgage holder may choose to securitize the mortgage instead of holding it as a whole loan.24 Mortgage securitization comes in many different forms, but generally speaking, the process involves a financial institution acquiring and combining (pooling together) many different mortgages and then issuing a mortgage-backed security (MBS). An MBS can be divided into different pieces, or tranches, that are sold to investors.25 The investors do not own the underlying mortgages but are buying the right to receive the future stream of payments that come from those mortgages. A servicer collects the payments of all the borrowers whose mortgages are part of the security and remits the payments to the investors. For investors, purchasing MBS offers several benefits compared with holding whole mortgages. Most notably, an MBS is generally more liquid than whole mortgages, meaning it is easier to quickly sell an MBS at the current price. Because the market for MBS is more liquid than the market for whole mortgages, MBS might be attractive to investors who would not otherwise choose to invest in mortgages. More investors in the mortgage market, in turn, can mean more funding is available for lenders to offer mortgages. More funding available in the primary market, and the existence of a secondary market where lenders know they can easily sell the mortgages they make, can result in lower interest rates that lenders charge to borrowers. Although securitization may have several advantages, it may also present several disadvantages. Securitization—and the secondary market in general—requires additional participants to facilitate the flow of credit than when a loan is held by the originator. Additional participants, with some acting on behalf of others, can increase costs and introduce competing incentives for the various participants and potential conflicts of interest. For example, more participants in the transaction may result in a principal-agent problem, a situation in which one entity (the agent) is supposed to work on behalf of another entity (the principal), but the agent may have an incentive to act in its own best interest rather than in the best interest of the principal. For example, mortgage servicers act on behalf of investors to evaluate a borrower for mortgage workout options or to begin the foreclosure process when a borrower falls behind on mortgage payments, as specified by a contract between the investor and the servicer. However, in some cases, a servicer may have an incentive to choose the option that is in its own best interest rather than in the best interest of the investor, and the investor might not be well positioned to police the servicer’s actions.26
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What are the risks associated with high interest rates on mortgages? Mortgage Classifications Mortgages can be classified into several categories based on their characteristics. The broadest distinction is between government-insured mortgages and conventional mortgages. Government- insured mortgages have mortgage insurance from a government agency, such as FHA, VA, or USDA, whereas conventional mortgages do not have government insurance. As previously noted, this insurance pays the lender if the borrower defaults. Borrowers can also be classified into two broad groups based on their credit history: prime and non-prime. Although there is no single agreed-upon definition, prime borrowers generally have very good credit and are offered more attractive mortgage terms, such as better interest rates, than non-prime borrowers. Non-prime borrowers exhibit one or more factors that make them appear riskier to lenders, such as past credit problems or a lack of complete income and asset documentation. Conventional mortgages can be broken down into two additional groups, conforming and nonconforming mortgages. Conforming loans are loans eligible to be purchased in the secondary market by Fannie Mae and Freddie Mac, two GSEs that are discussed later in this report. To be a conforming loan, the mortgage must meet certain creditworthiness thresholds (such as a minimum credit score) and be less than the “conforming loan limit,” a legal cap on the principal balance of the mortgage that can vary based on the geographic area where the house is located.18 Borrowers with conforming loans are usually prime borrowers. Nonconforming loans can be broken down into three additional categories depending on the reason they are not conforming. First, nonconforming loans above the conforming loan limit are called jumbo loans.19 Second, Alt-A loans are for near-prime borrowers who may have credit problems or who do not have complete documentation for income or assets. Third, subprime loans are generally for the riskiest borrowers; they either have low credit scores, documentation issues, or some other factor that makes them appear to be riskier to lenders. Subprime borrowers are likely to be charged a higher interest rate to compensate the lender for the additional risk.20 Risks Associated with Holding Mortgages When a lender originates a mortgage, it accepts certain risks. The three major risks are credit, prepayment, and funding risk. Credit risk refers to the risk that the lender bears if a borrower does not repay the mortgage on time. 21 Prepayment risk is the risk that a mortgage will be paid off sooner than expected, typically by a borrower refinancing the mortgage or selling the home. This is more likely to happen when interest rates fall, because borrowers are more likely to refinance their mortgages to take advantage of lower interest rates. 22 When a borrower refinances, the lender is paid in full the amount owed, but it now has to reinvest those funds at a time when its expected return on new investments is lower because interest rates have fallen. Although prepayment risk is a risk associated with falling interest rates, there are also risks for lenders that come from rising interest rates. One of these risks, called funding risk, arises because some lenders borrow money in the short term to fund long-term investments, such as 30-year mortgages. Short-term interest rates are typically lower than long-term interest rates because of the additional risk associated with lending money for a longer period of time. Lenders, therefore, can profit from the difference, or spread, between the short-term and long-term rates. If interest rates rise, then the lender will have to borrow funds at a higher interest rate, while still earning the same interest rate on the mortgage. As long as the short-term rate stays below the long-term return, the lender would profit on the difference, although its profits would be lower than if the short-term interest rates had not increased. If short-term rates increase above the fixed return on the mortgage, then the investment would no longer be profitable. Another lender’s risk associated with rising interest rates is opportunity costs. If interest rates rise, but lender’s money is tied up in long-term mortgages made at lower interest rates, then the lender is missing out on higher returns that it could be earning if it were able to originate mortgages or make other investments at the higher current interest rate. The lender that originates a mortgage does not necessarily have to bear all of the associated risks. In some cases, the borrower could bear some of these risks. Adjustable-rate mortgages, for example, transfer the risk that interest rates might rise from the lender to the borrower. Lenders can also sell mortgages to investors, who then bear the risks associated with the mortgage. The market for buying and selling mortgages is called the secondary market, which is described below. The Secondary Market After a lender originates a mortgage loan, the lender has several options. The lender could choose to hold the mortgage in its portfolio or sell it to another entity. Mortgages are bought and sold in the secondary market to domestic and international investors. When a mortgage is sold, the mortgage servicer may change. In any case, the borrower continues to send monthly mortgage payments to the mortgage servicer.23 The servicer remits the payments to the entity that purchased the mortgage. The secondary market plays an important role in providing funding for loans made in the primary market. When a mortgage is sold in the secondary market, the lender can use the proceeds to fund additional new mortgages in the primary market. If the lender holds the mortgage in its portfolio, the lender has fewer available funds to make new mortgages. Furthermore, selling the loan to another entity allows the lender to transfer mortgage lending risks to the buyer. Securitization When a lender sells a mortgage in the secondary market, the new mortgage holder can hold the mortgage as a whole loan. When held as a whole loan, the mortgage is in the portfolio of the new mortgage holder, and the new mortgage holder bears the risks associated with the mortgage. Alternatively, the new mortgage holder may choose to securitize the mortgage instead of holding it as a whole loan.24 Mortgage securitization comes in many different forms, but generally speaking, the process involves a financial institution acquiring and combining (pooling together) many different mortgages and then issuing a mortgage-backed security (MBS). An MBS can be divided into different pieces, or tranches, that are sold to investors.25 The investors do not own the underlying mortgages but are buying the right to receive the future stream of payments that come from those mortgages. A servicer collects the payments of all the borrowers whose mortgages are part of the security and remits the payments to the investors. For investors, purchasing MBS offers several benefits compared with holding whole mortgages. Most notably, an MBS is generally more liquid than whole mortgages, meaning it is easier to quickly sell an MBS at the current price. Because the market for MBS is more liquid than the market for whole mortgages, MBS might be attractive to investors who would not otherwise choose to invest in mortgages. More investors in the mortgage market, in turn, can mean more funding is available for lenders to offer mortgages. More funding available in the primary market, and the existence of a secondary market where lenders know they can easily sell the mortgages they make, can result in lower interest rates that lenders charge to borrowers. Although securitization may have several advantages, it may also present several disadvantages. Securitization—and the secondary market in general—requires additional participants to facilitate the flow of credit than when a loan is held by the originator. Additional participants, with some acting on behalf of others, can increase costs and introduce competing incentives for the various participants and potential conflicts of interest. For example, more participants in the transaction may result in a principal-agent problem, a situation in which one entity (the agent) is supposed to work on behalf of another entity (the principal), but the agent may have an incentive to act in its own best interest rather than in the best interest of the principal. For example, mortgage servicers act on behalf of investors to evaluate a borrower for mortgage workout options or to begin the foreclosure process when a borrower falls behind on mortgage payments, as specified by a contract between the investor and the servicer. However, in some cases, a servicer may have an incentive to choose the option that is in its own best interest rather than in the best interest of the investor, and the investor might not be well positioned to police the servicer’s actions.26 You are required to answer questions based solely on the information provided in the prompt. You will not use any outside resources or internal knowledge.
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You are required to answer questions based solely on the information provided in the prompt. You will not use any outside resources or internal knowledge.
EVIDENCE:
Mortgage Classifications Mortgages can be classified into several categories based on their characteristics. The broadest distinction is between government-insured mortgages and conventional mortgages. Government- insured mortgages have mortgage insurance from a government agency, such as FHA, VA, or USDA, whereas conventional mortgages do not have government insurance. As previously noted, this insurance pays the lender if the borrower defaults. Borrowers can also be classified into two broad groups based on their credit history: prime and non-prime. Although there is no single agreed-upon definition, prime borrowers generally have very good credit and are offered more attractive mortgage terms, such as better interest rates, than non-prime borrowers. Non-prime borrowers exhibit one or more factors that make them appear riskier to lenders, such as past credit problems or a lack of complete income and asset documentation. Conventional mortgages can be broken down into two additional groups, conforming and nonconforming mortgages. Conforming loans are loans eligible to be purchased in the secondary market by Fannie Mae and Freddie Mac, two GSEs that are discussed later in this report. To be a conforming loan, the mortgage must meet certain creditworthiness thresholds (such as a minimum credit score) and be less than the “conforming loan limit,” a legal cap on the principal balance of the mortgage that can vary based on the geographic area where the house is located.18 Borrowers with conforming loans are usually prime borrowers. Nonconforming loans can be broken down into three additional categories depending on the reason they are not conforming. First, nonconforming loans above the conforming loan limit are called jumbo loans.19 Second, Alt-A loans are for near-prime borrowers who may have credit problems or who do not have complete documentation for income or assets. Third, subprime loans are generally for the riskiest borrowers; they either have low credit scores, documentation issues, or some other factor that makes them appear to be riskier to lenders. Subprime borrowers are likely to be charged a higher interest rate to compensate the lender for the additional risk.20 Risks Associated with Holding Mortgages When a lender originates a mortgage, it accepts certain risks. The three major risks are credit, prepayment, and funding risk. Credit risk refers to the risk that the lender bears if a borrower does not repay the mortgage on time. 21 Prepayment risk is the risk that a mortgage will be paid off sooner than expected, typically by a borrower refinancing the mortgage or selling the home. This is more likely to happen when interest rates fall, because borrowers are more likely to refinance their mortgages to take advantage of lower interest rates. 22 When a borrower refinances, the lender is paid in full the amount owed, but it now has to reinvest those funds at a time when its expected return on new investments is lower because interest rates have fallen. Although prepayment risk is a risk associated with falling interest rates, there are also risks for lenders that come from rising interest rates. One of these risks, called funding risk, arises because some lenders borrow money in the short term to fund long-term investments, such as 30-year mortgages. Short-term interest rates are typically lower than long-term interest rates because of the additional risk associated with lending money for a longer period of time. Lenders, therefore, can profit from the difference, or spread, between the short-term and long-term rates. If interest rates rise, then the lender will have to borrow funds at a higher interest rate, while still earning the same interest rate on the mortgage. As long as the short-term rate stays below the long-term return, the lender would profit on the difference, although its profits would be lower than if the short-term interest rates had not increased. If short-term rates increase above the fixed return on the mortgage, then the investment would no longer be profitable. Another lender’s risk associated with rising interest rates is opportunity costs. If interest rates rise, but lender’s money is tied up in long-term mortgages made at lower interest rates, then the lender is missing out on higher returns that it could be earning if it were able to originate mortgages or make other investments at the higher current interest rate. The lender that originates a mortgage does not necessarily have to bear all of the associated risks. In some cases, the borrower could bear some of these risks. Adjustable-rate mortgages, for example, transfer the risk that interest rates might rise from the lender to the borrower. Lenders can also sell mortgages to investors, who then bear the risks associated with the mortgage. The market for buying and selling mortgages is called the secondary market, which is described below. The Secondary Market After a lender originates a mortgage loan, the lender has several options. The lender could choose to hold the mortgage in its portfolio or sell it to another entity. Mortgages are bought and sold in the secondary market to domestic and international investors. When a mortgage is sold, the mortgage servicer may change. In any case, the borrower continues to send monthly mortgage payments to the mortgage servicer.23 The servicer remits the payments to the entity that purchased the mortgage. The secondary market plays an important role in providing funding for loans made in the primary market. When a mortgage is sold in the secondary market, the lender can use the proceeds to fund additional new mortgages in the primary market. If the lender holds the mortgage in its portfolio, the lender has fewer available funds to make new mortgages. Furthermore, selling the loan to another entity allows the lender to transfer mortgage lending risks to the buyer. Securitization When a lender sells a mortgage in the secondary market, the new mortgage holder can hold the mortgage as a whole loan. When held as a whole loan, the mortgage is in the portfolio of the new mortgage holder, and the new mortgage holder bears the risks associated with the mortgage. Alternatively, the new mortgage holder may choose to securitize the mortgage instead of holding it as a whole loan.24 Mortgage securitization comes in many different forms, but generally speaking, the process involves a financial institution acquiring and combining (pooling together) many different mortgages and then issuing a mortgage-backed security (MBS). An MBS can be divided into different pieces, or tranches, that are sold to investors.25 The investors do not own the underlying mortgages but are buying the right to receive the future stream of payments that come from those mortgages. A servicer collects the payments of all the borrowers whose mortgages are part of the security and remits the payments to the investors. For investors, purchasing MBS offers several benefits compared with holding whole mortgages. Most notably, an MBS is generally more liquid than whole mortgages, meaning it is easier to quickly sell an MBS at the current price. Because the market for MBS is more liquid than the market for whole mortgages, MBS might be attractive to investors who would not otherwise choose to invest in mortgages. More investors in the mortgage market, in turn, can mean more funding is available for lenders to offer mortgages. More funding available in the primary market, and the existence of a secondary market where lenders know they can easily sell the mortgages they make, can result in lower interest rates that lenders charge to borrowers. Although securitization may have several advantages, it may also present several disadvantages. Securitization—and the secondary market in general—requires additional participants to facilitate the flow of credit than when a loan is held by the originator. Additional participants, with some acting on behalf of others, can increase costs and introduce competing incentives for the various participants and potential conflicts of interest. For example, more participants in the transaction may result in a principal-agent problem, a situation in which one entity (the agent) is supposed to work on behalf of another entity (the principal), but the agent may have an incentive to act in its own best interest rather than in the best interest of the principal. For example, mortgage servicers act on behalf of investors to evaluate a borrower for mortgage workout options or to begin the foreclosure process when a borrower falls behind on mortgage payments, as specified by a contract between the investor and the servicer. However, in some cases, a servicer may have an incentive to choose the option that is in its own best interest rather than in the best interest of the investor, and the investor might not be well positioned to police the servicer’s actions.26
USER:
What are the risks associated with high interest rates on mortgages?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
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In my economics class today, we read this article about the Laffer Curve. I'm rereading it at home and would like to gain a better understanding of how to apply it in practice. Would it be fair to say that lowering prohibitively low taxes will usually lead to increased tax revenue and how the Laffer curved is used? Please explain the reasoning, outlined in this reference text, that supports your answer in two to seven sentences.
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Tax Revenue versus Tax Rates: A Discussion of the Laffer Curve Named for economist Arthur Laffer, the Laffer curve is one of the few macroeconomic concepts with which the general public has at least a passing familiarity. However, it also is not well understood even by many who reference it. Economist Hal Varian once noted, “It has been said that the popularity of the Laffer curve is due to the fact that you can explain it to a Congressman in six minutes and he can talk about it for six months.” 1 This brief explains what the Laffer curve is and its implications for economic policy. In its most general form, the Laffer curve depicts the relationship between tax rates and the revenue the government receives–that is, a single tax rate exists that maximizes the amount of revenue the government obtains from taxation. Figure 1 below represents a graphical depiction of a Laffer curve. Figure 1. General form of a Laffer curve. The vertical axis of Figure 1 depicts the tax rate as a percentage, while the horizontal axis depicts revenues received in dollars. At both a tax rate of 0 percent and 100 percent total tax revenues equal zero. Point E represents the tax rate at which total revenues are maximized.2 The horizontal line through point E that bisects the curve represents two ranges of tax rates in terms of their relationship to revenues. Tax rates below this line indicate the normal range of rates, in which an increase in the tax rate corresponds to an increase in total revenues. Tax rates above this line correspond to the prohibitive range, in which an increase in tax rates results in a decrease in total revenues. Thus, any tax rate other than the rate corresponding to point E results in less revenue collected from the tax. Point E, notably, only represents the rate at which total tax revenues are maximized, not the optimal tax rate in terms of the rate that 1 Varian, H.R. (1989) “What Use is Economic Theory?” Available online at http://people.ischool.berkeley.edu/~hal/Papers/theory.pdf. Accessed 1 May 2017. 2 While point E in Figure 1 may appear to represent the midpoint between tax rates of 0 and 100 percent, it does not necessarily indicate a tax rate of 50 percent maximizes total revenues. [2] creates the fewest distortions in the economy. The vertical line through the curve marked by points A and B demonstrates how, because of the symmetric nature of the curve, two different tax rates can result in the same amount of total revenue. Point A represents a relatively high tax rate, slightly below 100 percent. Point B, conversely, represents a relatively low tax rate, slightly above 0 percent. Yet as the vertical line indicates the total tax revenue collected under these two rates is the same according to the Laffer curve. Points A and B, respectively, indicate that in theory, a high rate on a relatively small tax base generates the same revenue as a low tax rate on a relatively large tax base. The general form of the Laffer curve in Figure 1 does not specify the type of tax rates the government levies. While economists have studied numerous applications, the Laffer curve is usually used to describe the behavior of individual income tax rates levied either by the federal or a state government. In many analyses, economists use the Laffer curve to specifically refer to marginal income tax rates–the rate of tax paid on an additional dollar of income. Laffer describes the curve as illustrating two effects of tax rates on tax revenues.3 The first effect is the arithmetic effect, the increase (decrease) in tax revenues that results from an increase (decrease) in the tax rate. The second–and much more controversial–effect is the economic effect, the increase (decrease) in tax revenues resulting from a decrease (increase) in tax rates because of the incentives (disincentives) created to increase (decrease) work, output, and employment. Essentially the economic effect of the Laffer curve holds that reducing tax rates will motivate people to work more and produce more, leading to more revenue; raising tax rates produces the opposite effect. Laffer notes that the two effects are always in the opposite direction, so that the impact of a change in tax rates on revenues is not necessarily immediately clear. In order for a decrease in tax rates to increase revenues, for example, the rate must lie within the prohibitive range of tax rates as illustrated in Figure 1. In this range the economic effect is positive and larger than the arithmetic effect. Significantly, Laffer states that the curve “. . . does not say whether a tax cut will raise or lower revenues.” He maintains that what happens to revenues as a result of a tax rate change depends on a number of factors, such as “. . . the tax system in place, the time period being considered, the ease of movement into underground activities, the level of tax rates already in place,” and “the prevalence of legal and accounting-driven tax loopholes. . .” Thus, individuals who argue the Laffer curve always holds that a tax cut leads to an increase in tax revenues– whether for good or for ill–misrepresent what it hypothesizes. The Laffer curve has been controversial throughout its forty-year-plus history. One of the chief criticisms inflicted against it is determining where a current tax system lies on the curve; i.e., where the tax rate is in relation to point E in Figure 1. Some economists developed a formula that uses income elasticities and other parameters to determine the rate at which point E occurs. This formula finds that the rate equals around 70 percent.4 Other economists also 3 Laffer, A.B. (2004) “The Laffer Curve: Past, Present, and Future.” Executive Summary Backgrounder No. 1765. The Heritage Foundation. 4 Matthews, D. (2010) “Where does the Laffer curve bend?” The Washington Post. 9 August. Available online at http://voices.washingtonpost.com/ezra-klein/2010/08/where_does_the_laffer_curve_be.html. Accessed 2 May 2017. [3] venture the rate corresponding to point E lies in the range of 70 percent; however, other economists contend the rate is considerably lower. Another criticism of the Laffer curve is a lack of empirical evidence. Arthur Laffer cites several instances in U.S. history and in other countries as examples of “Laffer curve effects.” However, the inherent complexities of most systems of taxation as well as other complicating factors make isolating the impacts of specific rate changes difficult in practice. This situation leads to another criticism of the Laffer curve, which is because it focuses on a single rate, it oversimplifies the analysis of tax rate changes. In conclusion, the Laffer curve continues to influence policymakers at the state and national level both in and outside of the U.S. It is an economic concept with ardent defenders and equally ardent detractors. However, the Laffer curve’s most significant contribution may be how it serves as a jumping off point for serious economic policy discussions involving the structure of income tax systems and how individuals respond to these different structures.
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. In my economics class today, we read this article about the Laffer Curve. I'm rereading it at home and would like to gain a better understanding of how to apply it in practice. Would it be fair to say that lowering prohibitively low taxes will usually lead to increased tax revenue and how the Laffer curved is used? Please explain the reasoning, outlined in this reference text, that supports your answer in two to seven sentences. Tax Revenue versus Tax Rates: A Discussion of the Laffer Curve Named for economist Arthur Laffer, the Laffer curve is one of the few macroeconomic concepts with which the general public has at least a passing familiarity. However, it also is not well understood even by many who reference it. Economist Hal Varian once noted, “It has been said that the popularity of the Laffer curve is due to the fact that you can explain it to a Congressman in six minutes and he can talk about it for six months.” 1 This brief explains what the Laffer curve is and its implications for economic policy. In its most general form, the Laffer curve depicts the relationship between tax rates and the revenue the government receives–that is, a single tax rate exists that maximizes the amount of revenue the government obtains from taxation. Figure 1 below represents a graphical depiction of a Laffer curve. Figure 1. General form of a Laffer curve. The vertical axis of Figure 1 depicts the tax rate as a percentage, while the horizontal axis depicts revenues received in dollars. At both a tax rate of 0 percent and 100 percent total tax revenues equal zero. Point E represents the tax rate at which total revenues are maximized.2 The horizontal line through point E that bisects the curve represents two ranges of tax rates in terms of their relationship to revenues. Tax rates below this line indicate the normal range of rates, in which an increase in the tax rate corresponds to an increase in total revenues. Tax rates above this line correspond to the prohibitive range, in which an increase in tax rates results in a decrease in total revenues. Thus, any tax rate other than the rate corresponding to point E results in less revenue collected from the tax. Point E, notably, only represents the rate at which total tax revenues are maximized, not the optimal tax rate in terms of the rate that 1 Varian, H.R. (1989) “What Use is Economic Theory?” Available online at http://people.ischool.berkeley.edu/~hal/Papers/theory.pdf. Accessed 1 May 2017. 2 While point E in Figure 1 may appear to represent the midpoint between tax rates of 0 and 100 percent, it does not necessarily indicate a tax rate of 50 percent maximizes total revenues. [2] creates the fewest distortions in the economy. The vertical line through the curve marked by points A and B demonstrates how, because of the symmetric nature of the curve, two different tax rates can result in the same amount of total revenue. Point A represents a relatively high tax rate, slightly below 100 percent. Point B, conversely, represents a relatively low tax rate, slightly above 0 percent. Yet as the vertical line indicates the total tax revenue collected under these two rates is the same according to the Laffer curve. Points A and B, respectively, indicate that in theory, a high rate on a relatively small tax base generates the same revenue as a low tax rate on a relatively large tax base. The general form of the Laffer curve in Figure 1 does not specify the type of tax rates the government levies. While economists have studied numerous applications, the Laffer curve is usually used to describe the behavior of individual income tax rates levied either by the federal or a state government. In many analyses, economists use the Laffer curve to specifically refer to marginal income tax rates–the rate of tax paid on an additional dollar of income. Laffer describes the curve as illustrating two effects of tax rates on tax revenues.3 The first effect is the arithmetic effect, the increase (decrease) in tax revenues that results from an increase (decrease) in the tax rate. The second–and much more controversial–effect is the economic effect, the increase (decrease) in tax revenues resulting from a decrease (increase) in tax rates because of the incentives (disincentives) created to increase (decrease) work, output, and employment. Essentially the economic effect of the Laffer curve holds that reducing tax rates will motivate people to work more and produce more, leading to more revenue; raising tax rates produces the opposite effect. Laffer notes that the two effects are always in the opposite direction, so that the impact of a change in tax rates on revenues is not necessarily immediately clear. In order for a decrease in tax rates to increase revenues, for example, the rate must lie within the prohibitive range of tax rates as illustrated in Figure 1. In this range the economic effect is positive and larger than the arithmetic effect. Significantly, Laffer states that the curve “. . . does not say whether a tax cut will raise or lower revenues.” He maintains that what happens to revenues as a result of a tax rate change depends on a number of factors, such as “. . . the tax system in place, the time period being considered, the ease of movement into underground activities, the level of tax rates already in place,” and “the prevalence of legal and accounting-driven tax loopholes. . .” Thus, individuals who argue the Laffer curve always holds that a tax cut leads to an increase in tax revenues– whether for good or for ill–misrepresent what it hypothesizes. The Laffer curve has been controversial throughout its forty-year-plus history. One of the chief criticisms inflicted against it is determining where a current tax system lies on the curve; i.e., where the tax rate is in relation to point E in Figure 1. Some economists developed a formula that uses income elasticities and other parameters to determine the rate at which point E occurs. This formula finds that the rate equals around 70 percent.4 Other economists also 3 Laffer, A.B. (2004) “The Laffer Curve: Past, Present, and Future.” Executive Summary Backgrounder No. 1765. The Heritage Foundation. 4 Matthews, D. (2010) “Where does the Laffer curve bend?” The Washington Post. 9 August. Available online at http://voices.washingtonpost.com/ezra-klein/2010/08/where_does_the_laffer_curve_be.html. Accessed 2 May 2017. [3] venture the rate corresponding to point E lies in the range of 70 percent; however, other economists contend the rate is considerably lower. Another criticism of the Laffer curve is a lack of empirical evidence. Arthur Laffer cites several instances in U.S. history and in other countries as examples of “Laffer curve effects.” However, the inherent complexities of most systems of taxation as well as other complicating factors make isolating the impacts of specific rate changes difficult in practice. This situation leads to another criticism of the Laffer curve, which is because it focuses on a single rate, it oversimplifies the analysis of tax rate changes. In conclusion, the Laffer curve continues to influence policymakers at the state and national level both in and outside of the U.S. It is an economic concept with ardent defenders and equally ardent detractors. However, the Laffer curve’s most significant contribution may be how it serves as a jumping off point for serious economic policy discussions involving the structure of income tax systems and how individuals respond to these different structures. http://www.mississippi.edu/urc/downloads/laffer_curve.pdf
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
Tax Revenue versus Tax Rates: A Discussion of the Laffer Curve Named for economist Arthur Laffer, the Laffer curve is one of the few macroeconomic concepts with which the general public has at least a passing familiarity. However, it also is not well understood even by many who reference it. Economist Hal Varian once noted, “It has been said that the popularity of the Laffer curve is due to the fact that you can explain it to a Congressman in six minutes and he can talk about it for six months.” 1 This brief explains what the Laffer curve is and its implications for economic policy. In its most general form, the Laffer curve depicts the relationship between tax rates and the revenue the government receives–that is, a single tax rate exists that maximizes the amount of revenue the government obtains from taxation. Figure 1 below represents a graphical depiction of a Laffer curve. Figure 1. General form of a Laffer curve. The vertical axis of Figure 1 depicts the tax rate as a percentage, while the horizontal axis depicts revenues received in dollars. At both a tax rate of 0 percent and 100 percent total tax revenues equal zero. Point E represents the tax rate at which total revenues are maximized.2 The horizontal line through point E that bisects the curve represents two ranges of tax rates in terms of their relationship to revenues. Tax rates below this line indicate the normal range of rates, in which an increase in the tax rate corresponds to an increase in total revenues. Tax rates above this line correspond to the prohibitive range, in which an increase in tax rates results in a decrease in total revenues. Thus, any tax rate other than the rate corresponding to point E results in less revenue collected from the tax. Point E, notably, only represents the rate at which total tax revenues are maximized, not the optimal tax rate in terms of the rate that 1 Varian, H.R. (1989) “What Use is Economic Theory?” Available online at http://people.ischool.berkeley.edu/~hal/Papers/theory.pdf. Accessed 1 May 2017. 2 While point E in Figure 1 may appear to represent the midpoint between tax rates of 0 and 100 percent, it does not necessarily indicate a tax rate of 50 percent maximizes total revenues. [2] creates the fewest distortions in the economy. The vertical line through the curve marked by points A and B demonstrates how, because of the symmetric nature of the curve, two different tax rates can result in the same amount of total revenue. Point A represents a relatively high tax rate, slightly below 100 percent. Point B, conversely, represents a relatively low tax rate, slightly above 0 percent. Yet as the vertical line indicates the total tax revenue collected under these two rates is the same according to the Laffer curve. Points A and B, respectively, indicate that in theory, a high rate on a relatively small tax base generates the same revenue as a low tax rate on a relatively large tax base. The general form of the Laffer curve in Figure 1 does not specify the type of tax rates the government levies. While economists have studied numerous applications, the Laffer curve is usually used to describe the behavior of individual income tax rates levied either by the federal or a state government. In many analyses, economists use the Laffer curve to specifically refer to marginal income tax rates–the rate of tax paid on an additional dollar of income. Laffer describes the curve as illustrating two effects of tax rates on tax revenues.3 The first effect is the arithmetic effect, the increase (decrease) in tax revenues that results from an increase (decrease) in the tax rate. The second–and much more controversial–effect is the economic effect, the increase (decrease) in tax revenues resulting from a decrease (increase) in tax rates because of the incentives (disincentives) created to increase (decrease) work, output, and employment. Essentially the economic effect of the Laffer curve holds that reducing tax rates will motivate people to work more and produce more, leading to more revenue; raising tax rates produces the opposite effect. Laffer notes that the two effects are always in the opposite direction, so that the impact of a change in tax rates on revenues is not necessarily immediately clear. In order for a decrease in tax rates to increase revenues, for example, the rate must lie within the prohibitive range of tax rates as illustrated in Figure 1. In this range the economic effect is positive and larger than the arithmetic effect. Significantly, Laffer states that the curve “. . . does not say whether a tax cut will raise or lower revenues.” He maintains that what happens to revenues as a result of a tax rate change depends on a number of factors, such as “. . . the tax system in place, the time period being considered, the ease of movement into underground activities, the level of tax rates already in place,” and “the prevalence of legal and accounting-driven tax loopholes. . .” Thus, individuals who argue the Laffer curve always holds that a tax cut leads to an increase in tax revenues– whether for good or for ill–misrepresent what it hypothesizes. The Laffer curve has been controversial throughout its forty-year-plus history. One of the chief criticisms inflicted against it is determining where a current tax system lies on the curve; i.e., where the tax rate is in relation to point E in Figure 1. Some economists developed a formula that uses income elasticities and other parameters to determine the rate at which point E occurs. This formula finds that the rate equals around 70 percent.4 Other economists also 3 Laffer, A.B. (2004) “The Laffer Curve: Past, Present, and Future.” Executive Summary Backgrounder No. 1765. The Heritage Foundation. 4 Matthews, D. (2010) “Where does the Laffer curve bend?” The Washington Post. 9 August. Available online at http://voices.washingtonpost.com/ezra-klein/2010/08/where_does_the_laffer_curve_be.html. Accessed 2 May 2017. [3] venture the rate corresponding to point E lies in the range of 70 percent; however, other economists contend the rate is considerably lower. Another criticism of the Laffer curve is a lack of empirical evidence. Arthur Laffer cites several instances in U.S. history and in other countries as examples of “Laffer curve effects.” However, the inherent complexities of most systems of taxation as well as other complicating factors make isolating the impacts of specific rate changes difficult in practice. This situation leads to another criticism of the Laffer curve, which is because it focuses on a single rate, it oversimplifies the analysis of tax rate changes. In conclusion, the Laffer curve continues to influence policymakers at the state and national level both in and outside of the U.S. It is an economic concept with ardent defenders and equally ardent detractors. However, the Laffer curve’s most significant contribution may be how it serves as a jumping off point for serious economic policy discussions involving the structure of income tax systems and how individuals respond to these different structures.
USER:
In my economics class today, we read this article about the Laffer Curve. I'm rereading it at home and would like to gain a better understanding of how to apply it in practice. Would it be fair to say that lowering prohibitively low taxes will usually lead to increased tax revenue and how the Laffer curved is used? Please explain the reasoning, outlined in this reference text, that supports your answer in two to seven sentences.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 24 | 76 | 1,170 | null | 748 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
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If I have an athletic scholarship and attending a U.S. College with a Visa, can I get an NIL? Use a real life example from someone explaining a legal situation as I do not want to try to comprehend too much jargon.
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In June 2021, the long debate over whether college athletes should get paid gained some momentum as the National Collegiate Athletic Association (NCAA) passed its name, image, and likeness (NIL) policy, which enables student-athletes to be compensated for their names, images, and likenesses. This policy, which permitted athletes to pursue commercials, social media endorsements, and merchandise, for starters, served as a game changer for UC San Diego athletes by giving them opportunities to earn income while still maintaining their amateur status. UCSD second-year basketball player and Sixth College Public Health major Francis Nwaokorie is all for it. “I think it’s really good to allow athletes to build their brand up at such a young age and potentially provide for their families in the future,” Nwaokorie said. While Nwaokorie did not consider NIL deals during his freshman year when the NIL policy was new to collegiate athletics, he is starting to look more into NIL deals this year. “Coming in as a freshman last year, I had a lot of offers for NIL deals, but I was really focused on the season and trying to make sure I got playing time and didn’t want to get distracted with that stuff at that time,” Nwaokorie said. “Now, as a sophomore, I’m starting to look more into that stuff now that I am more experienced.” Second-year soccer player Andrew Valverde, a Sixth College Political Science major, transferred from UCLA to UCSD after his freshman season and believes that soccer is one of the sports that lacks the attention that some other high-profile sports like football and basketball receive. Football and basketball receive the most compensation in the NIL market, leaving other sports far behind. However, Valverde has been able to sign multiple NIL deals. “I have had the luck to secure great deals with great sponsors. I was a student-athlete ambassador for a soccer clothing brand called CRKSOLY., and they gave me opportunities to showcase myself and their brand,” Valverde said. “I also have been able to get a sponsorship through a trainer and have access to get free training.” Valverde mentioned the continued struggle most athletes face to find a NIL deal. “I do wish UCSD makes sponsorships more available for all its athletes and maybe more training so athletes know what they are getting into,” Valverde said. “Basketball and soccer may be [some] of the more high profile sports on the NCAA stage but for some sports, the opportunity to maximize their NIL may be tied to their respective schools.” According to Jeff Tourial, UCSD’s Associate Athletic Director, the resources are there for students. “We have created a portal on our website that answers many questions our scholar-athletes may have. In addition, our compliance staff has created a dedicated email address to further provide one-on-one guidance as needed. The Big West partnered with Compass in 2021 to provide a portal assisting SA [student-athletes] in deals,” Tourial stated. Though UCSD’s location in San Diego can mean that there are plenty of opportunities for student-athletes to capitalize on, UCSD’s conference affiliation limits its national exposure to a tier below other schools in the Pac-12 conference such as UCLA, USC, and UC Berkeley — schools that are more known for their athletics and can spend more on athletics, draw in better athletes, and bring more recognition toward their athletes in terms of media exposure. While this does not necessarily mean the NIL opportunities are not there, UCSD student-athletes may have a harder time signing more lucrative NIL deals compared to student-athletes from other schools. “I know a few people on other teams who have made deals with Liquid IV,” UCSD fourth-year water polo player and Eleanor Roosevelt College (ERC) Business Psychology major Kayla Peacock said. “They mostly get merchandise and products, depending on the company.” According to Peacock, there is some frustration regarding the NIL deals’ ambiguous criteria. NIL deals’ criteria states that athletes still have to adhere to school policies and state laws. “My only criticism of NIL is that we were trying to get our team to be sponsored by Crocs and they sent us a discount code and we weren’t allowed to use it. I don’t really understand why. So my complaint is that the rules are unclear for us as scholar-athletes,” Peacock said. NIL opportunities are not available for every student-athlete. For Derek Rong, they are nonexistent. Rong, a first-year ERC Business Economics major, is from Canada and is living in the U.S. on a student visa. Although the visa permits Rong to work on campus, the visa stipulates that he cannot work for a business outside of his college. “I think international students should be able to have the same opportunities,“ stated Rong, who is a fencer. “It’s more about the athlete’s performance and influence. I don’t have any deals, but I would love to explore them.“ This might be the start of a push for more rights for college athletes in California. A bill in the formative stages could see student-athletes earn a share of the revenue tied to graduation. Essentially, athletes could make up a maximum of $25,000 per year and excess money would be placed in a fund that they can access if they graduate within six years. With Division I athletics raking in $15.8 billion in revenue, there is still a lot of money left at the table. “Certainly, I feel like that [increased rights for college athletes] can really help student-athletes who aren’t in the best situation income-wise at home and also help student-athletes pay for more things they need like airfare/transportation back home or even just to have extra money just in case of an emergency,” Nwaokorie said.
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== If I have an athletic scholarship and attending a U.S. College with a Visa, can I get an NIL? Use a real life example from someone explaining a legal situation as I do not want to try to comprehend too much jargon. {passage 0} ========== In June 2021, the long debate over whether college athletes should get paid gained some momentum as the National Collegiate Athletic Association (NCAA) passed its name, image, and likeness (NIL) policy, which enables student-athletes to be compensated for their names, images, and likenesses. This policy, which permitted athletes to pursue commercials, social media endorsements, and merchandise, for starters, served as a game changer for UC San Diego athletes by giving them opportunities to earn income while still maintaining their amateur status. UCSD second-year basketball player and Sixth College Public Health major Francis Nwaokorie is all for it. “I think it’s really good to allow athletes to build their brand up at such a young age and potentially provide for their families in the future,” Nwaokorie said. While Nwaokorie did not consider NIL deals during his freshman year when the NIL policy was new to collegiate athletics, he is starting to look more into NIL deals this year. “Coming in as a freshman last year, I had a lot of offers for NIL deals, but I was really focused on the season and trying to make sure I got playing time and didn’t want to get distracted with that stuff at that time,” Nwaokorie said. “Now, as a sophomore, I’m starting to look more into that stuff now that I am more experienced.” Second-year soccer player Andrew Valverde, a Sixth College Political Science major, transferred from UCLA to UCSD after his freshman season and believes that soccer is one of the sports that lacks the attention that some other high-profile sports like football and basketball receive. Football and basketball receive the most compensation in the NIL market, leaving other sports far behind. However, Valverde has been able to sign multiple NIL deals. “I have had the luck to secure great deals with great sponsors. I was a student-athlete ambassador for a soccer clothing brand called CRKSOLY., and they gave me opportunities to showcase myself and their brand,” Valverde said. “I also have been able to get a sponsorship through a trainer and have access to get free training.” Valverde mentioned the continued struggle most athletes face to find a NIL deal. “I do wish UCSD makes sponsorships more available for all its athletes and maybe more training so athletes know what they are getting into,” Valverde said. “Basketball and soccer may be [some] of the more high profile sports on the NCAA stage but for some sports, the opportunity to maximize their NIL may be tied to their respective schools.” According to Jeff Tourial, UCSD’s Associate Athletic Director, the resources are there for students. “We have created a portal on our website that answers many questions our scholar-athletes may have. In addition, our compliance staff has created a dedicated email address to further provide one-on-one guidance as needed. The Big West partnered with Compass in 2021 to provide a portal assisting SA [student-athletes] in deals,” Tourial stated. Though UCSD’s location in San Diego can mean that there are plenty of opportunities for student-athletes to capitalize on, UCSD’s conference affiliation limits its national exposure to a tier below other schools in the Pac-12 conference such as UCLA, USC, and UC Berkeley — schools that are more known for their athletics and can spend more on athletics, draw in better athletes, and bring more recognition toward their athletes in terms of media exposure. While this does not necessarily mean the NIL opportunities are not there, UCSD student-athletes may have a harder time signing more lucrative NIL deals compared to student-athletes from other schools. “I know a few people on other teams who have made deals with Liquid IV,” UCSD fourth-year water polo player and Eleanor Roosevelt College (ERC) Business Psychology major Kayla Peacock said. “They mostly get merchandise and products, depending on the company.” According to Peacock, there is some frustration regarding the NIL deals’ ambiguous criteria. NIL deals’ criteria states that athletes still have to adhere to school policies and state laws. “My only criticism of NIL is that we were trying to get our team to be sponsored by Crocs and they sent us a discount code and we weren’t allowed to use it. I don’t really understand why. So my complaint is that the rules are unclear for us as scholar-athletes,” Peacock said. NIL opportunities are not available for every student-athlete. For Derek Rong, they are nonexistent. Rong, a first-year ERC Business Economics major, is from Canada and is living in the U.S. on a student visa. Although the visa permits Rong to work on campus, the visa stipulates that he cannot work for a business outside of his college. “I think international students should be able to have the same opportunities,“ stated Rong, who is a fencer. “It’s more about the athlete’s performance and influence. I don’t have any deals, but I would love to explore them.“ This might be the start of a push for more rights for college athletes in California. A bill in the formative stages could see student-athletes earn a share of the revenue tied to graduation. Essentially, athletes could make up a maximum of $25,000 per year and excess money would be placed in a fund that they can access if they graduate within six years. With Division I athletics raking in $15.8 billion in revenue, there is still a lot of money left at the table. “Certainly, I feel like that [increased rights for college athletes] can really help student-athletes who aren’t in the best situation income-wise at home and also help student-athletes pay for more things they need like airfare/transportation back home or even just to have extra money just in case of an emergency,” Nwaokorie said. https://triton.news/2023/05/nil-deals-bring-more-frustration-than-they-see-fit/
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
In June 2021, the long debate over whether college athletes should get paid gained some momentum as the National Collegiate Athletic Association (NCAA) passed its name, image, and likeness (NIL) policy, which enables student-athletes to be compensated for their names, images, and likenesses. This policy, which permitted athletes to pursue commercials, social media endorsements, and merchandise, for starters, served as a game changer for UC San Diego athletes by giving them opportunities to earn income while still maintaining their amateur status. UCSD second-year basketball player and Sixth College Public Health major Francis Nwaokorie is all for it. “I think it’s really good to allow athletes to build their brand up at such a young age and potentially provide for their families in the future,” Nwaokorie said. While Nwaokorie did not consider NIL deals during his freshman year when the NIL policy was new to collegiate athletics, he is starting to look more into NIL deals this year. “Coming in as a freshman last year, I had a lot of offers for NIL deals, but I was really focused on the season and trying to make sure I got playing time and didn’t want to get distracted with that stuff at that time,” Nwaokorie said. “Now, as a sophomore, I’m starting to look more into that stuff now that I am more experienced.” Second-year soccer player Andrew Valverde, a Sixth College Political Science major, transferred from UCLA to UCSD after his freshman season and believes that soccer is one of the sports that lacks the attention that some other high-profile sports like football and basketball receive. Football and basketball receive the most compensation in the NIL market, leaving other sports far behind. However, Valverde has been able to sign multiple NIL deals. “I have had the luck to secure great deals with great sponsors. I was a student-athlete ambassador for a soccer clothing brand called CRKSOLY., and they gave me opportunities to showcase myself and their brand,” Valverde said. “I also have been able to get a sponsorship through a trainer and have access to get free training.” Valverde mentioned the continued struggle most athletes face to find a NIL deal. “I do wish UCSD makes sponsorships more available for all its athletes and maybe more training so athletes know what they are getting into,” Valverde said. “Basketball and soccer may be [some] of the more high profile sports on the NCAA stage but for some sports, the opportunity to maximize their NIL may be tied to their respective schools.” According to Jeff Tourial, UCSD’s Associate Athletic Director, the resources are there for students. “We have created a portal on our website that answers many questions our scholar-athletes may have. In addition, our compliance staff has created a dedicated email address to further provide one-on-one guidance as needed. The Big West partnered with Compass in 2021 to provide a portal assisting SA [student-athletes] in deals,” Tourial stated. Though UCSD’s location in San Diego can mean that there are plenty of opportunities for student-athletes to capitalize on, UCSD’s conference affiliation limits its national exposure to a tier below other schools in the Pac-12 conference such as UCLA, USC, and UC Berkeley — schools that are more known for their athletics and can spend more on athletics, draw in better athletes, and bring more recognition toward their athletes in terms of media exposure. While this does not necessarily mean the NIL opportunities are not there, UCSD student-athletes may have a harder time signing more lucrative NIL deals compared to student-athletes from other schools. “I know a few people on other teams who have made deals with Liquid IV,” UCSD fourth-year water polo player and Eleanor Roosevelt College (ERC) Business Psychology major Kayla Peacock said. “They mostly get merchandise and products, depending on the company.” According to Peacock, there is some frustration regarding the NIL deals’ ambiguous criteria. NIL deals’ criteria states that athletes still have to adhere to school policies and state laws. “My only criticism of NIL is that we were trying to get our team to be sponsored by Crocs and they sent us a discount code and we weren’t allowed to use it. I don’t really understand why. So my complaint is that the rules are unclear for us as scholar-athletes,” Peacock said. NIL opportunities are not available for every student-athlete. For Derek Rong, they are nonexistent. Rong, a first-year ERC Business Economics major, is from Canada and is living in the U.S. on a student visa. Although the visa permits Rong to work on campus, the visa stipulates that he cannot work for a business outside of his college. “I think international students should be able to have the same opportunities,“ stated Rong, who is a fencer. “It’s more about the athlete’s performance and influence. I don’t have any deals, but I would love to explore them.“ This might be the start of a push for more rights for college athletes in California. A bill in the formative stages could see student-athletes earn a share of the revenue tied to graduation. Essentially, athletes could make up a maximum of $25,000 per year and excess money would be placed in a fund that they can access if they graduate within six years. With Division I athletics raking in $15.8 billion in revenue, there is still a lot of money left at the table. “Certainly, I feel like that [increased rights for college athletes] can really help student-athletes who aren’t in the best situation income-wise at home and also help student-athletes pay for more things they need like airfare/transportation back home or even just to have extra money just in case of an emergency,” Nwaokorie said.
USER:
If I have an athletic scholarship and attending a U.S. College with a Visa, can I get an NIL? Use a real life example from someone explaining a legal situation as I do not want to try to comprehend too much jargon.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 42 | 945 | null | 84 |
Use only the information provided in the Prompt to answer any questions. You may not use any previous knowledge or external resources. Limit your answer to a maximum of 150 words.
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Please summarize the given text into two paragraphs at most, and do not include multiple subheadings; all of the information should be under a singular title.
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Program Caps Program caps, sometimes called aggregate capacity limits, set limits on the number of customers or amount of generation capacity that may participate. Program caps can be expressed in units of power (e.g., megawatts; MW),39 a percentage of electricity demand over some period of time, or other measures as determined by a state. The choice of whether to have program caps and, if so, how to define them can affect the amount of DG that a state’s net metering policy might promote.40 Program caps may be established to reduce risks to the electricity system, such as potential reliability risks from DG, or reduce the likelihood that cross-subsidies would occur. Caps also might reduce the potential for sales losses or other negative financial impacts for utilities.41 On the other hand, program caps might create a barrier to achieving other policy goals, for example the renewable energy goals that some states have. Source Eligibility States specify which generation sources can participate in net metering, often based on capacity limits (i.e., generator size) and technology type. Solar energy is the dominant energy source for net metering capacity, but some states allow other energy types to participate as well. Whether a non-solar project will participate is usually due to cost factors, but other factors such as customer type (e.g., residential, commercial, or industrial) and location (e.g., urban, rural) may be influential as well. For example, combined heat and power facilities might be attractive mostly to large commercial and industrial customers that use steam. Distributed wind projects might be attractive mostly to farms or other customers with relatively large acreage.
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Use only the information provided in the Prompt to answer any questions. You may not use any previous knowledge or external resources. Limit your answer to a maximum of 150 words. Please summarize the given text into two paragraphs at most, and do not include multiple subheadings; all of the information should be under a singular title. Program Caps Program caps, sometimes called aggregate capacity limits, set limits on the number of customers or amount of generation capacity that may participate. Program caps can be expressed in units of power (e.g., megawatts; MW),39 a percentage of electricity demand over some period of time, or other measures as determined by a state. The choice of whether to have program caps and, if so, how to define them can affect the amount of DG that a state’s net metering policy might promote.40 Program caps may be established to reduce risks to the electricity system, such as potential reliability risks from DG, or reduce the likelihood that cross-subsidies would occur. Caps also might reduce the potential for sales losses or other negative financial impacts for utilities.41 On the other hand, program caps might create a barrier to achieving other policy goals, for example the renewable energy goals that some states have. Source Eligibility States specify which generation sources can participate in net metering, often based on capacity limits (i.e., generator size) and technology type. Solar energy is the dominant energy source for net metering capacity, but some states allow other energy types to participate as well. Whether a non-solar project will participate is usually due to cost factors, but other factors such as customer type (e.g., residential, commercial, or industrial) and location (e.g., urban, rural) may be influential as well. For example, combined heat and power facilities might be attractive mostly to large commercial and industrial customers that use steam. Distributed wind projects might be attractive mostly to farms or other customers with relatively large acreage.
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Use only the information provided in the Prompt to answer any questions. You may not use any previous knowledge or external resources. Limit your answer to a maximum of 150 words.
EVIDENCE:
Program Caps Program caps, sometimes called aggregate capacity limits, set limits on the number of customers or amount of generation capacity that may participate. Program caps can be expressed in units of power (e.g., megawatts; MW),39 a percentage of electricity demand over some period of time, or other measures as determined by a state. The choice of whether to have program caps and, if so, how to define them can affect the amount of DG that a state’s net metering policy might promote.40 Program caps may be established to reduce risks to the electricity system, such as potential reliability risks from DG, or reduce the likelihood that cross-subsidies would occur. Caps also might reduce the potential for sales losses or other negative financial impacts for utilities.41 On the other hand, program caps might create a barrier to achieving other policy goals, for example the renewable energy goals that some states have. Source Eligibility States specify which generation sources can participate in net metering, often based on capacity limits (i.e., generator size) and technology type. Solar energy is the dominant energy source for net metering capacity, but some states allow other energy types to participate as well. Whether a non-solar project will participate is usually due to cost factors, but other factors such as customer type (e.g., residential, commercial, or industrial) and location (e.g., urban, rural) may be influential as well. For example, combined heat and power facilities might be attractive mostly to large commercial and industrial customers that use steam. Distributed wind projects might be attractive mostly to farms or other customers with relatively large acreage.
USER:
Please summarize the given text into two paragraphs at most, and do not include multiple subheadings; all of the information should be under a singular title.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 31 | 26 | 266 | null | 569 |
You are given a reference document. You must only use information found in the reference document to answer the question asked.
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What are Joe Dispenza's core teachings?
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Breaking the Habit of Being Yourself By Dr.Joe Dispenza Big Idea #1: To Change Your Life, Change Your Thoughts This idea is actually in the very first chapter of the book. Dr. Joe Dispenza starts off explaining how our beliefs or thoughts, lead to our feelings which lead to our actions which ultimately leads to our results. This is exactly the same as the concept of ‘TFAR’ in T. Harv Eker’s book ‘The Millionaire Mind”. However, instead of giving simple practical examples, Dr. Joe Dispenza uses the concept of Quantum Physics and other physics concepts to prove this point. Basically, everything in the physical universe is made up of subatomic particles such as electrons. These particles exist as pure potential. They are in their wave state when they’re not being observed. These particles are potential ‘everything’ and ‘nothing’ until they are observed. Hence everything in our physical reality exists as pure potential. What Dispenza means by being ‘observed’ is when we don’t actively look out for it. But when we do see it and ‘observe’ it, we can start to act upon it. What this ultimately implies is that the quantum field or the universe for this matter contains a reality in anything you want. So if you want to become a millionaire, the universe contains a reality in which you are a millionaire. And since our consciousness has effects on energy, we are powerful enough to influence matter. (I know this is a bit too technical but stay with me). Now, the whole point of using this concept of quantum physics is to prove only one point. We can master our skills of observation to intentionally affect our destiny, our life, and our results. In this case, Dispenza uses ‘observation’ to mean we can master what we ‘focus’ on to change our results. To quote Henry Ford: “Whether you think you can, or you think you can’t, you’re right” – Henry Ford For example, I had a friend who was quite miserable at his job. He wanted a pay rise but didn’t think he’d deserve it so he would never ask. A month later, something happened at work and he was blamed for something he didn’t do. He was really mad and thought staying in this job just isn’t worth it for the amount of pay he was getting. So he wanted to quit. But before he quit, he asked for a pay rise first because he had nothing to lose. To his surprise, his boss actually gave him a 10% pay rise. He was delighted and didn’t end up quitting. Now the sudden change in his thoughts to think of himself worthy of getting a pay rise – was the change in his skill to ‘observe’, his ability to change his ‘focus’. He first focused on how h ewasn’t worth an increase in salary to focussing on the fact that the job wasn’t worth him staying. Dispenza says that that the potential of him getting that salary increase was always there. It was there even when he was miserable a month earlier. In fact, even if his job would say no, there still exists a potential situation in the universe where he’d get a 10% pay increase. Maybe this would’ve been through another job. Whatever it is you want, the potential is there. The only missing link is whether we have the ability to ‘observe’, to change our ‘focus’ to look it or not. Big Idea #2: Live Your Desired New Future In the Present Dispenza teaches us that our brain doesn’t know the difference between the internal world (what we imagine in our heads) to what we experience in the external environment. That is, our thoughts can become our experience. This is what Napoleon Hill also said in his book Think & Grow Rich. The reason why we think how we think and do what we do is not that of who we are. Remember, we only act because of our thoughts. This concept is extremely important because as quoted above, we can imagine ourselves being someone totally different. We can imagine a more successful life with more confidence, with more friends and so on. This is a very similar concept of “The New Self Image” by Maxwell Maltz in his book Psycho-Cybernetics. When explaining these kinds of concepts, I like to break it down even more. In layman’s terms, if you’re able to imagine success and everything that it involves in vivid details, even down to the amount of money and house structure. And live that life in the present, meaning living that success right now in the present regardless of your situations, you will manifest it. For example if you want to become a millionaire. Think of how a millionaire would think, act, do, how their house would look like etc. First act in that way. And you will slowly attract the quantum potential of you being a millionaire into your life. It’s like, first you have to be a millionaire kind of person to actually become a millionaire. Now, I know this may sound very weird and bit B.S. but here are some examples that you may relate to. Think of manifesting like dating. For example, imagine your perfect ideal partner in life. You don’t really care about the nitty gritty of how they look but you have to be attracted to them and they have to have the same values and be ambitious in life. Now imagine if they existed, what would they want in their perfect partner? They would want you to also be established. Be caring. Be funny. All that. So even if you’d meet your perfect partner in real life, you’d miss your chance because you’re not the type of person they’re looking for. Chances are even if they’d walk past you on the streets, you won’t even see or notice them because deep down you don’t think you deserve them so you don’t look out for them. Hence think of manifesting like dating. You have to become first, then you will receive. So applying this concept to the previous scenario with my friend wanting to earn 100k, if he just acted, and thought of himself as already being a 100k type of person, asking for that pay rise would be a no brainer to him. Another example is if you want to become a public speaker – the kind that gets invited speak on TED Talks. First treat yourself as that kind of person already and you will slowly see more opportunities to public speak. It’s all about changing our focus to become better ‘observers’ so that we can attract our goal into our life. These questions will help you find your desired new future. Also, when you’re done answering these questions and have a better understanding what your new desired future looks like. Remember not to live in the future but to bring it to the present. Live it in the present and feel the emotions, feel the happiness and feel everything that comes with it. More importantly, act and think like you’re living in the future but in the present. So when choices comes up and when situations arrives, deal with them as if the future you is dealing with them. Big Idea #3: Three Brains: From Thinking To Doing To Being We have three brains. The first brain is the Neocortex, which is responsible for our thoughts. The second brain is the Limbic brain, which is responsible for our emotions. The third brain is the Cerebellum, which is responsible for our habitual thoughts, attitudes, and behaviors. And this is how we learn things. First, we think about the new concept, then we act on the new concept. Once we act on it enough, we can be the new concept. For example, you don’t want to have as much of a temper anymore so instead you want to learn how to be more compassionate. So you immerse yourself in studying compassionate people like Mother Teresa and the Dalai Lama. Everything on how they think, act and what they believed. Now you know exactly how to think like them. The second step after thinking is doing. So a situation comes up where your partner does something you extremely hate. If that was the old you, you would’ve started an argument. But since you just studied how to be compassionate, you start to act compassionately instead. At this stage, Dispenza explains that the act of doing represents us teaching our body what our mind has learned. So the first step was for the mind to learn. This second step is for the body to learn. But acting compassionate in only one situation doesn’t necessarily make you a compassionate person. So what you have to do is act it out repeatedly. Only when you act compassionate repeatedly enough, you’ll move on to ‘being‘ compassionate. At this stage, Dispenza explains you no longer have to think of being compassionate, you just are. Being is when your body acts without needing a signal from the mind. It’s natural, routine, second nature and unconscious. He goes further to say that to master being is when our internal chemical state is greater than anything in our external world. That is no matter how many times someone pushes your buttons or no matter how messy the house looks, nothing in your external environment can make you get mad since you want to be compassionate. And the thing is this might sound foreign to you. As if ‘mastery’ is something very difficult to achieve. But the truth is, we have attained the mastery level. Just not on traits we might like. In fact Dispenza says ‘if you can master suffering, you can just as easily master joy’ – Dr. Joe Dispenza To demonstrate this I have to give you this example from the book which I find demonstrates this so well and at the same time is hilarious. You probably know someone who has mastered suffering, right? So you call her and ask, “How are you?” She answers “So-So.” You go on and say “Listen, I’m going to go out with some friends to a new art gallery and then eat at this restaurant that has really healthy desserts. Afterward, we’re going to listen to some live music. Would you like to come with us?” And after a long pause, your friend answers “No. I don’t feel like it.” But if she said what she actually meant, she’d say, I’ve memorized this emotional state, and nothing in my environment – no person, no experience, no condition, no thing – is going to move me from my internal chemical state of suffering. It feels better to be in pain than to let go and be happy. I am enjoying my addiction for now, and all these things that you want to do might distract me from my emotional dependency. So guess what? We can just as easily master an internal chemical state such as joy or compassion as we can and we do for suffering. This also goes mastering our internal state of thinking we’re not good enough. Which is the most common internal state most of us have. Big Idea #4: The Identity Gap This was one of my favorite ideas from the book. I could resonate with this idea. Dispenza starts off the chapter by telling us what kind of person he used to be before all of this. He had the money, he had the job, he traveled around the world to teach and he had a great family. From the outside, it looked like his life was perfect. But even he didn’t know why even having the perfect life didn’t make him happy. And no it didn’t have anything to do with being grateful for what he had. It was the fact that there was a huge gap in his two identities. Dispenza explains that everyone has two identities: The first is the identity of how you see yourself. The second is the identity of how you appear to others. There’s a gap because we usually don’t want others to see who we truly are inside. So it’s like we put on this front and have two identities. The thing is the second identity was actually created by us to hide our first identity. But now and then the first identity (our true identity) comes out and we try suppressing it further by changing our external world. But what we actually have to do is change our internal world. Dispenza defines happiness as closing this gap. The gap was created because we memorized many emotional layers such as unworthiness, anger, fear, shame, self-doubt, and guilt. Hence our life’s aim is to close this gap. To really show who we truly are inside. This is what will make us ultimately fulfilled. Being self-expressed creates happiness. And we can do this by unlearning and un-memorizing these emotional states. We can do it the long way as explained in Big Idea #3, but the faster way, which is to skip from thinking to just being can be done through meditation. That’s when Dispenza introduces his Step By Step Meditation Guide to do just that. Big Idea #5: Breaking The Habit Of Being Yourself Through Meditation Dispenza explains that one of the main purposes of meditation is to go beyond the conscious mind and enter the subconscious mind, in order to change selfdestructive habits, behaviors, belief, emotional reactions, attitudes, and unconscious states of being. That is, we can skip the doing, to go straight from thinking to being. The power of meditation actually allows us to become more observant within ourselves. It allows us to break our emotional bond with the body, the environment and time. This helps with “Breaking The Habits Of Being Yourself” and helps with creating new thoughts and emotions that are congruent with the new future you. We can actually skip the acting part and just move into being through meditation. Hence Part 3 of the book includes a step-by-step guide to Meditation. It’s a 6- week program where Dr. Joe Dispenza shares tools, resources, how to and the reason behind everything. Unlike other books that only just have concepts and little action plans. Dr. Joe Dispenza has gone out of his way to explain every little step and to designing a meditation specifically aimed to have you break the habit of being yourself. He even includes guided meditations and many other resources on his website to help best perform this meditation. Conclusion: As you can see Breaking The Habit Of Being Yourself reviews concepts that are quite philosophical. I’ve read many similar books like Psycho-Cybernetics, Think & Grow Rich, Secrets Of The Millionaire Mind and The Magic Of Thinking Big just to name a few. They all share one important key concept that actions and results all start from our thoughts. Breaking The Habits Of Being Yourself doesn’t just say statements like ‘Change your thoughts to change your life’, instead it taps into many different concepts of physics, biology, neuroscience and many others to prove that this is not just philosophical but instead a fact. A fact that not many people are taking advantage of. I guess my last words on this is that if you’re willing to be open minded and take the book for what it is instead of nit picking every little thing and actually apply the strategies it shares, I’m certain it will have a positive impact on your life. Go ahead, give it a read and break the habit of being yourself to become the new you. Your Breaking The Habit Of Being Yourself Action Plan Choose your top 3 new traits.For example being compassionate, being bold and caring. Immerse yourself into studying on how to be just that by researching famous figures who embody that trait. Act out those 3 traits.Whenever you get a chance, ask yourself “What would a compassionate person do?” And do this. Do this enough times until you don’t need to consciously remember to be compassionate anymore. Do this for all 3 traits. Unlearn your worst 3 traits. Choose the top 3 traits that you don’t like about yourself. This could also include beliefs about yourself. Beliefs such as I’m not good enough. To unlearn it, take actions no matter how small to prove that you are good enough. And when you do, consciously write them down so you can remember it. Once you build up this bank of examples where you proved to yourself that you are good enough, slowly your old belief will just fall away. Of course, you can also do the meditation to unlearn these traits quicker. However, I’d suggest reading the book first in this case. Quotes: “Can you accept the notion that once you change your internal state, you don’t need the external world to provide you with a reason to feel joy, gratitude, appreciation, or any other elevated emotion?” “A memory without the emotional charge is called wisdom.” “We should never wait for science to give us permission to do the uncommon; if we do, then we are turning science into another religion.” “If you want a new outcome, you will have to break the habit of being yourself, and reinvent a new self.” “Think of it this way: the input remains the same, so the output has to remain the same. How, then, can you ever create anything new?” “The quantum field responds not to what we want; it responds to who we are being.” “By Itself, Conscious Positive Thinking Cannot Overcome Subconscious Negative Feelings” Sources: https://bestbookbits.com/breaking-the-habit-of-being-yourself-dr-joedispenza-book-summary-bestbookbits-com/ https://www.goodreads.com/work/quotes/18108532-breaking-the-habit-ofbeing-yourself-how-to-lose-your-mind-and-create-a
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You are given a reference document. You must only use information found in the reference document to answer the question asked. What are Joe Dispenza's core teachings? Breaking the Habit of Being Yourself By Dr.Joe Dispenza Big Idea #1: To Change Your Life, Change Your Thoughts This idea is actually in the very first chapter of the book. Dr. Joe Dispenza starts off explaining how our beliefs or thoughts, lead to our feelings which lead to our actions which ultimately leads to our results. This is exactly the same as the concept of ‘TFAR’ in T. Harv Eker’s book ‘The Millionaire Mind”. However, instead of giving simple practical examples, Dr. Joe Dispenza uses the concept of Quantum Physics and other physics concepts to prove this point. Basically, everything in the physical universe is made up of subatomic particles such as electrons. These particles exist as pure potential. They are in their wave state when they’re not being observed. These particles are potential ‘everything’ and ‘nothing’ until they are observed. Hence everything in our physical reality exists as pure potential. What Dispenza means by being ‘observed’ is when we don’t actively look out for it. But when we do see it and ‘observe’ it, we can start to act upon it. What this ultimately implies is that the quantum field or the universe for this matter contains a reality in anything you want. So if you want to become a millionaire, the universe contains a reality in which you are a millionaire. And since our consciousness has effects on energy, we are powerful enough to influence matter. (I know this is a bit too technical but stay with me). Now, the whole point of using this concept of quantum physics is to prove only one point. We can master our skills of observation to intentionally affect our destiny, our life, and our results. In this case, Dispenza uses ‘observation’ to mean we can master what we ‘focus’ on to change our results. To quote Henry Ford: “Whether you think you can, or you think you can’t, you’re right” – Henry Ford For example, I had a friend who was quite miserable at his job. He wanted a pay rise but didn’t think he’d deserve it so he would never ask. A month later, something happened at work and he was blamed for something he didn’t do. He was really mad and thought staying in this job just isn’t worth it for the amount of pay he was getting. So he wanted to quit. But before he quit, he asked for a pay rise first because he had nothing to lose. To his surprise, his boss actually gave him a 10% pay rise. He was delighted and didn’t end up quitting. Now the sudden change in his thoughts to think of himself worthy of getting a pay rise – was the change in his skill to ‘observe’, his ability to change his ‘focus’. He first focused on how h ewasn’t worth an increase in salary to focussing on the fact that the job wasn’t worth him staying. Dispenza says that that the potential of him getting that salary increase was always there. It was there even when he was miserable a month earlier. In fact, even if his job would say no, there still exists a potential situation in the universe where he’d get a 10% pay increase. Maybe this would’ve been through another job. Whatever it is you want, the potential is there. The only missing link is whether we have the ability to ‘observe’, to change our ‘focus’ to look it or not. Big Idea #2: Live Your Desired New Future In the Present Dispenza teaches us that our brain doesn’t know the difference between the internal world (what we imagine in our heads) to what we experience in the external environment. That is, our thoughts can become our experience. This is what Napoleon Hill also said in his book Think & Grow Rich. The reason why we think how we think and do what we do is not that of who we are. Remember, we only act because of our thoughts. This concept is extremely important because as quoted above, we can imagine ourselves being someone totally different. We can imagine a more successful life with more confidence, with more friends and so on. This is a very similar concept of “The New Self Image” by Maxwell Maltz in his book Psycho-Cybernetics. When explaining these kinds of concepts, I like to break it down even more. In layman’s terms, if you’re able to imagine success and everything that it involves in vivid details, even down to the amount of money and house structure. And live that life in the present, meaning living that success right now in the present regardless of your situations, you will manifest it. For example if you want to become a millionaire. Think of how a millionaire would think, act, do, how their house would look like etc. First act in that way. And you will slowly attract the quantum potential of you being a millionaire into your life. It’s like, first you have to be a millionaire kind of person to actually become a millionaire. Now, I know this may sound very weird and bit B.S. but here are some examples that you may relate to. Think of manifesting like dating. For example, imagine your perfect ideal partner in life. You don’t really care about the nitty gritty of how they look but you have to be attracted to them and they have to have the same values and be ambitious in life. Now imagine if they existed, what would they want in their perfect partner? They would want you to also be established. Be caring. Be funny. All that. So even if you’d meet your perfect partner in real life, you’d miss your chance because you’re not the type of person they’re looking for. Chances are even if they’d walk past you on the streets, you won’t even see or notice them because deep down you don’t think you deserve them so you don’t look out for them. Hence think of manifesting like dating. You have to become first, then you will receive. So applying this concept to the previous scenario with my friend wanting to earn 100k, if he just acted, and thought of himself as already being a 100k type of person, asking for that pay rise would be a no brainer to him. Another example is if you want to become a public speaker – the kind that gets invited speak on TED Talks. First treat yourself as that kind of person already and you will slowly see more opportunities to public speak. It’s all about changing our focus to become better ‘observers’ so that we can attract our goal into our life. These questions will help you find your desired new future. Also, when you’re done answering these questions and have a better understanding what your new desired future looks like. Remember not to live in the future but to bring it to the present. Live it in the present and feel the emotions, feel the happiness and feel everything that comes with it. More importantly, act and think like you’re living in the future but in the present. So when choices comes up and when situations arrives, deal with them as if the future you is dealing with them. Big Idea #3: Three Brains: From Thinking To Doing To Being We have three brains. The first brain is the Neocortex, which is responsible for our thoughts. The second brain is the Limbic brain, which is responsible for our emotions. The third brain is the Cerebellum, which is responsible for our habitual thoughts, attitudes, and behaviors. And this is how we learn things. First, we think about the new concept, then we act on the new concept. Once we act on it enough, we can be the new concept. For example, you don’t want to have as much of a temper anymore so instead you want to learn how to be more compassionate. So you immerse yourself in studying compassionate people like Mother Teresa and the Dalai Lama. Everything on how they think, act and what they believed. Now you know exactly how to think like them. The second step after thinking is doing. So a situation comes up where your partner does something you extremely hate. If that was the old you, you would’ve started an argument. But since you just studied how to be compassionate, you start to act compassionately instead. At this stage, Dispenza explains that the act of doing represents us teaching our body what our mind has learned. So the first step was for the mind to learn. This second step is for the body to learn. But acting compassionate in only one situation doesn’t necessarily make you a compassionate person. So what you have to do is act it out repeatedly. Only when you act compassionate repeatedly enough, you’ll move on to ‘being‘ compassionate. At this stage, Dispenza explains you no longer have to think of being compassionate, you just are. Being is when your body acts without needing a signal from the mind. It’s natural, routine, second nature and unconscious. He goes further to say that to master being is when our internal chemical state is greater than anything in our external world. That is no matter how many times someone pushes your buttons or no matter how messy the house looks, nothing in your external environment can make you get mad since you want to be compassionate. And the thing is this might sound foreign to you. As if ‘mastery’ is something very difficult to achieve. But the truth is, we have attained the mastery level. Just not on traits we might like. In fact Dispenza says ‘if you can master suffering, you can just as easily master joy’ – Dr. Joe Dispenza To demonstrate this I have to give you this example from the book which I find demonstrates this so well and at the same time is hilarious. You probably know someone who has mastered suffering, right? So you call her and ask, “How are you?” She answers “So-So.” You go on and say “Listen, I’m going to go out with some friends to a new art gallery and then eat at this restaurant that has really healthy desserts. Afterward, we’re going to listen to some live music. Would you like to come with us?” And after a long pause, your friend answers “No. I don’t feel like it.” But if she said what she actually meant, she’d say, I’ve memorized this emotional state, and nothing in my environment – no person, no experience, no condition, no thing – is going to move me from my internal chemical state of suffering. It feels better to be in pain than to let go and be happy. I am enjoying my addiction for now, and all these things that you want to do might distract me from my emotional dependency. So guess what? We can just as easily master an internal chemical state such as joy or compassion as we can and we do for suffering. This also goes mastering our internal state of thinking we’re not good enough. Which is the most common internal state most of us have. Big Idea #4: The Identity Gap This was one of my favorite ideas from the book. I could resonate with this idea. Dispenza starts off the chapter by telling us what kind of person he used to be before all of this. He had the money, he had the job, he traveled around the world to teach and he had a great family. From the outside, it looked like his life was perfect. But even he didn’t know why even having the perfect life didn’t make him happy. And no it didn’t have anything to do with being grateful for what he had. It was the fact that there was a huge gap in his two identities. Dispenza explains that everyone has two identities: The first is the identity of how you see yourself. The second is the identity of how you appear to others. There’s a gap because we usually don’t want others to see who we truly are inside. So it’s like we put on this front and have two identities. The thing is the second identity was actually created by us to hide our first identity. But now and then the first identity (our true identity) comes out and we try suppressing it further by changing our external world. But what we actually have to do is change our internal world. Dispenza defines happiness as closing this gap. The gap was created because we memorized many emotional layers such as unworthiness, anger, fear, shame, self-doubt, and guilt. Hence our life’s aim is to close this gap. To really show who we truly are inside. This is what will make us ultimately fulfilled. Being self-expressed creates happiness. And we can do this by unlearning and un-memorizing these emotional states. We can do it the long way as explained in Big Idea #3, but the faster way, which is to skip from thinking to just being can be done through meditation. That’s when Dispenza introduces his Step By Step Meditation Guide to do just that. Big Idea #5: Breaking The Habit Of Being Yourself Through Meditation Dispenza explains that one of the main purposes of meditation is to go beyond the conscious mind and enter the subconscious mind, in order to change selfdestructive habits, behaviors, belief, emotional reactions, attitudes, and unconscious states of being. That is, we can skip the doing, to go straight from thinking to being. The power of meditation actually allows us to become more observant within ourselves. It allows us to break our emotional bond with the body, the environment and time. This helps with “Breaking The Habits Of Being Yourself” and helps with creating new thoughts and emotions that are congruent with the new future you. We can actually skip the acting part and just move into being through meditation. Hence Part 3 of the book includes a step-by-step guide to Meditation. It’s a 6- week program where Dr. Joe Dispenza shares tools, resources, how to and the reason behind everything. Unlike other books that only just have concepts and little action plans. Dr. Joe Dispenza has gone out of his way to explain every little step and to designing a meditation specifically aimed to have you break the habit of being yourself. He even includes guided meditations and many other resources on his website to help best perform this meditation. Conclusion: As you can see Breaking The Habit Of Being Yourself reviews concepts that are quite philosophical. I’ve read many similar books like Psycho-Cybernetics, Think & Grow Rich, Secrets Of The Millionaire Mind and The Magic Of Thinking Big just to name a few. They all share one important key concept that actions and results all start from our thoughts. Breaking The Habits Of Being Yourself doesn’t just say statements like ‘Change your thoughts to change your life’, instead it taps into many different concepts of physics, biology, neuroscience and many others to prove that this is not just philosophical but instead a fact. A fact that not many people are taking advantage of. I guess my last words on this is that if you’re willing to be open minded and take the book for what it is instead of nit picking every little thing and actually apply the strategies it shares, I’m certain it will have a positive impact on your life. Go ahead, give it a read and break the habit of being yourself to become the new you. Your Breaking The Habit Of Being Yourself Action Plan Choose your top 3 new traits.For example being compassionate, being bold and caring. Immerse yourself into studying on how to be just that by researching famous figures who embody that trait. Act out those 3 traits.Whenever you get a chance, ask yourself “What would a compassionate person do?” And do this. Do this enough times until you don’t need to consciously remember to be compassionate anymore. Do this for all 3 traits. Unlearn your worst 3 traits. Choose the top 3 traits that you don’t like about yourself. This could also include beliefs about yourself. Beliefs such as I’m not good enough. To unlearn it, take actions no matter how small to prove that you are good enough. And when you do, consciously write them down so you can remember it. Once you build up this bank of examples where you proved to yourself that you are good enough, slowly your old belief will just fall away. Of course, you can also do the meditation to unlearn these traits quicker. However, I’d suggest reading the book first in this case. Quotes: “Can you accept the notion that once you change your internal state, you don’t need the external world to provide you with a reason to feel joy, gratitude, appreciation, or any other elevated emotion?” “A memory without the emotional charge is called wisdom.” “We should never wait for science to give us permission to do the uncommon; if we do, then we are turning science into another religion.” “If you want a new outcome, you will have to break the habit of being yourself, and reinvent a new self.” “Think of it this way: the input remains the same, so the output has to remain the same. How, then, can you ever create anything new?” “The quantum field responds not to what we want; it responds to who we are being.” “By Itself, Conscious Positive Thinking Cannot Overcome Subconscious Negative Feelings” Sources: https://bestbookbits.com/breaking-the-habit-of-being-yourself-dr-joedispenza-book-summary-bestbookbits-com/ https://www.goodreads.com/work/quotes/18108532-breaking-the-habit-ofbeing-yourself-how-to-lose-your-mind-and-create-a
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You are given a reference document. You must only use information found in the reference document to answer the question asked.
EVIDENCE:
Breaking the Habit of Being Yourself By Dr.Joe Dispenza Big Idea #1: To Change Your Life, Change Your Thoughts This idea is actually in the very first chapter of the book. Dr. Joe Dispenza starts off explaining how our beliefs or thoughts, lead to our feelings which lead to our actions which ultimately leads to our results. This is exactly the same as the concept of ‘TFAR’ in T. Harv Eker’s book ‘The Millionaire Mind”. However, instead of giving simple practical examples, Dr. Joe Dispenza uses the concept of Quantum Physics and other physics concepts to prove this point. Basically, everything in the physical universe is made up of subatomic particles such as electrons. These particles exist as pure potential. They are in their wave state when they’re not being observed. These particles are potential ‘everything’ and ‘nothing’ until they are observed. Hence everything in our physical reality exists as pure potential. What Dispenza means by being ‘observed’ is when we don’t actively look out for it. But when we do see it and ‘observe’ it, we can start to act upon it. What this ultimately implies is that the quantum field or the universe for this matter contains a reality in anything you want. So if you want to become a millionaire, the universe contains a reality in which you are a millionaire. And since our consciousness has effects on energy, we are powerful enough to influence matter. (I know this is a bit too technical but stay with me). Now, the whole point of using this concept of quantum physics is to prove only one point. We can master our skills of observation to intentionally affect our destiny, our life, and our results. In this case, Dispenza uses ‘observation’ to mean we can master what we ‘focus’ on to change our results. To quote Henry Ford: “Whether you think you can, or you think you can’t, you’re right” – Henry Ford For example, I had a friend who was quite miserable at his job. He wanted a pay rise but didn’t think he’d deserve it so he would never ask. A month later, something happened at work and he was blamed for something he didn’t do. He was really mad and thought staying in this job just isn’t worth it for the amount of pay he was getting. So he wanted to quit. But before he quit, he asked for a pay rise first because he had nothing to lose. To his surprise, his boss actually gave him a 10% pay rise. He was delighted and didn’t end up quitting. Now the sudden change in his thoughts to think of himself worthy of getting a pay rise – was the change in his skill to ‘observe’, his ability to change his ‘focus’. He first focused on how h ewasn’t worth an increase in salary to focussing on the fact that the job wasn’t worth him staying. Dispenza says that that the potential of him getting that salary increase was always there. It was there even when he was miserable a month earlier. In fact, even if his job would say no, there still exists a potential situation in the universe where he’d get a 10% pay increase. Maybe this would’ve been through another job. Whatever it is you want, the potential is there. The only missing link is whether we have the ability to ‘observe’, to change our ‘focus’ to look it or not. Big Idea #2: Live Your Desired New Future In the Present Dispenza teaches us that our brain doesn’t know the difference between the internal world (what we imagine in our heads) to what we experience in the external environment. That is, our thoughts can become our experience. This is what Napoleon Hill also said in his book Think & Grow Rich. The reason why we think how we think and do what we do is not that of who we are. Remember, we only act because of our thoughts. This concept is extremely important because as quoted above, we can imagine ourselves being someone totally different. We can imagine a more successful life with more confidence, with more friends and so on. This is a very similar concept of “The New Self Image” by Maxwell Maltz in his book Psycho-Cybernetics. When explaining these kinds of concepts, I like to break it down even more. In layman’s terms, if you’re able to imagine success and everything that it involves in vivid details, even down to the amount of money and house structure. And live that life in the present, meaning living that success right now in the present regardless of your situations, you will manifest it. For example if you want to become a millionaire. Think of how a millionaire would think, act, do, how their house would look like etc. First act in that way. And you will slowly attract the quantum potential of you being a millionaire into your life. It’s like, first you have to be a millionaire kind of person to actually become a millionaire. Now, I know this may sound very weird and bit B.S. but here are some examples that you may relate to. Think of manifesting like dating. For example, imagine your perfect ideal partner in life. You don’t really care about the nitty gritty of how they look but you have to be attracted to them and they have to have the same values and be ambitious in life. Now imagine if they existed, what would they want in their perfect partner? They would want you to also be established. Be caring. Be funny. All that. So even if you’d meet your perfect partner in real life, you’d miss your chance because you’re not the type of person they’re looking for. Chances are even if they’d walk past you on the streets, you won’t even see or notice them because deep down you don’t think you deserve them so you don’t look out for them. Hence think of manifesting like dating. You have to become first, then you will receive. So applying this concept to the previous scenario with my friend wanting to earn 100k, if he just acted, and thought of himself as already being a 100k type of person, asking for that pay rise would be a no brainer to him. Another example is if you want to become a public speaker – the kind that gets invited speak on TED Talks. First treat yourself as that kind of person already and you will slowly see more opportunities to public speak. It’s all about changing our focus to become better ‘observers’ so that we can attract our goal into our life. These questions will help you find your desired new future. Also, when you’re done answering these questions and have a better understanding what your new desired future looks like. Remember not to live in the future but to bring it to the present. Live it in the present and feel the emotions, feel the happiness and feel everything that comes with it. More importantly, act and think like you’re living in the future but in the present. So when choices comes up and when situations arrives, deal with them as if the future you is dealing with them. Big Idea #3: Three Brains: From Thinking To Doing To Being We have three brains. The first brain is the Neocortex, which is responsible for our thoughts. The second brain is the Limbic brain, which is responsible for our emotions. The third brain is the Cerebellum, which is responsible for our habitual thoughts, attitudes, and behaviors. And this is how we learn things. First, we think about the new concept, then we act on the new concept. Once we act on it enough, we can be the new concept. For example, you don’t want to have as much of a temper anymore so instead you want to learn how to be more compassionate. So you immerse yourself in studying compassionate people like Mother Teresa and the Dalai Lama. Everything on how they think, act and what they believed. Now you know exactly how to think like them. The second step after thinking is doing. So a situation comes up where your partner does something you extremely hate. If that was the old you, you would’ve started an argument. But since you just studied how to be compassionate, you start to act compassionately instead. At this stage, Dispenza explains that the act of doing represents us teaching our body what our mind has learned. So the first step was for the mind to learn. This second step is for the body to learn. But acting compassionate in only one situation doesn’t necessarily make you a compassionate person. So what you have to do is act it out repeatedly. Only when you act compassionate repeatedly enough, you’ll move on to ‘being‘ compassionate. At this stage, Dispenza explains you no longer have to think of being compassionate, you just are. Being is when your body acts without needing a signal from the mind. It’s natural, routine, second nature and unconscious. He goes further to say that to master being is when our internal chemical state is greater than anything in our external world. That is no matter how many times someone pushes your buttons or no matter how messy the house looks, nothing in your external environment can make you get mad since you want to be compassionate. And the thing is this might sound foreign to you. As if ‘mastery’ is something very difficult to achieve. But the truth is, we have attained the mastery level. Just not on traits we might like. In fact Dispenza says ‘if you can master suffering, you can just as easily master joy’ – Dr. Joe Dispenza To demonstrate this I have to give you this example from the book which I find demonstrates this so well and at the same time is hilarious. You probably know someone who has mastered suffering, right? So you call her and ask, “How are you?” She answers “So-So.” You go on and say “Listen, I’m going to go out with some friends to a new art gallery and then eat at this restaurant that has really healthy desserts. Afterward, we’re going to listen to some live music. Would you like to come with us?” And after a long pause, your friend answers “No. I don’t feel like it.” But if she said what she actually meant, she’d say, I’ve memorized this emotional state, and nothing in my environment – no person, no experience, no condition, no thing – is going to move me from my internal chemical state of suffering. It feels better to be in pain than to let go and be happy. I am enjoying my addiction for now, and all these things that you want to do might distract me from my emotional dependency. So guess what? We can just as easily master an internal chemical state such as joy or compassion as we can and we do for suffering. This also goes mastering our internal state of thinking we’re not good enough. Which is the most common internal state most of us have. Big Idea #4: The Identity Gap This was one of my favorite ideas from the book. I could resonate with this idea. Dispenza starts off the chapter by telling us what kind of person he used to be before all of this. He had the money, he had the job, he traveled around the world to teach and he had a great family. From the outside, it looked like his life was perfect. But even he didn’t know why even having the perfect life didn’t make him happy. And no it didn’t have anything to do with being grateful for what he had. It was the fact that there was a huge gap in his two identities. Dispenza explains that everyone has two identities: The first is the identity of how you see yourself. The second is the identity of how you appear to others. There’s a gap because we usually don’t want others to see who we truly are inside. So it’s like we put on this front and have two identities. The thing is the second identity was actually created by us to hide our first identity. But now and then the first identity (our true identity) comes out and we try suppressing it further by changing our external world. But what we actually have to do is change our internal world. Dispenza defines happiness as closing this gap. The gap was created because we memorized many emotional layers such as unworthiness, anger, fear, shame, self-doubt, and guilt. Hence our life’s aim is to close this gap. To really show who we truly are inside. This is what will make us ultimately fulfilled. Being self-expressed creates happiness. And we can do this by unlearning and un-memorizing these emotional states. We can do it the long way as explained in Big Idea #3, but the faster way, which is to skip from thinking to just being can be done through meditation. That’s when Dispenza introduces his Step By Step Meditation Guide to do just that. Big Idea #5: Breaking The Habit Of Being Yourself Through Meditation Dispenza explains that one of the main purposes of meditation is to go beyond the conscious mind and enter the subconscious mind, in order to change selfdestructive habits, behaviors, belief, emotional reactions, attitudes, and unconscious states of being. That is, we can skip the doing, to go straight from thinking to being. The power of meditation actually allows us to become more observant within ourselves. It allows us to break our emotional bond with the body, the environment and time. This helps with “Breaking The Habits Of Being Yourself” and helps with creating new thoughts and emotions that are congruent with the new future you. We can actually skip the acting part and just move into being through meditation. Hence Part 3 of the book includes a step-by-step guide to Meditation. It’s a 6- week program where Dr. Joe Dispenza shares tools, resources, how to and the reason behind everything. Unlike other books that only just have concepts and little action plans. Dr. Joe Dispenza has gone out of his way to explain every little step and to designing a meditation specifically aimed to have you break the habit of being yourself. He even includes guided meditations and many other resources on his website to help best perform this meditation. Conclusion: As you can see Breaking The Habit Of Being Yourself reviews concepts that are quite philosophical. I’ve read many similar books like Psycho-Cybernetics, Think & Grow Rich, Secrets Of The Millionaire Mind and The Magic Of Thinking Big just to name a few. They all share one important key concept that actions and results all start from our thoughts. Breaking The Habits Of Being Yourself doesn’t just say statements like ‘Change your thoughts to change your life’, instead it taps into many different concepts of physics, biology, neuroscience and many others to prove that this is not just philosophical but instead a fact. A fact that not many people are taking advantage of. I guess my last words on this is that if you’re willing to be open minded and take the book for what it is instead of nit picking every little thing and actually apply the strategies it shares, I’m certain it will have a positive impact on your life. Go ahead, give it a read and break the habit of being yourself to become the new you. Your Breaking The Habit Of Being Yourself Action Plan Choose your top 3 new traits.For example being compassionate, being bold and caring. Immerse yourself into studying on how to be just that by researching famous figures who embody that trait. Act out those 3 traits.Whenever you get a chance, ask yourself “What would a compassionate person do?” And do this. Do this enough times until you don’t need to consciously remember to be compassionate anymore. Do this for all 3 traits. Unlearn your worst 3 traits. Choose the top 3 traits that you don’t like about yourself. This could also include beliefs about yourself. Beliefs such as I’m not good enough. To unlearn it, take actions no matter how small to prove that you are good enough. And when you do, consciously write them down so you can remember it. Once you build up this bank of examples where you proved to yourself that you are good enough, slowly your old belief will just fall away. Of course, you can also do the meditation to unlearn these traits quicker. However, I’d suggest reading the book first in this case. Quotes: “Can you accept the notion that once you change your internal state, you don’t need the external world to provide you with a reason to feel joy, gratitude, appreciation, or any other elevated emotion?” “A memory without the emotional charge is called wisdom.” “We should never wait for science to give us permission to do the uncommon; if we do, then we are turning science into another religion.” “If you want a new outcome, you will have to break the habit of being yourself, and reinvent a new self.” “Think of it this way: the input remains the same, so the output has to remain the same. How, then, can you ever create anything new?” “The quantum field responds not to what we want; it responds to who we are being.” “By Itself, Conscious Positive Thinking Cannot Overcome Subconscious Negative Feelings” Sources: https://bestbookbits.com/breaking-the-habit-of-being-yourself-dr-joedispenza-book-summary-bestbookbits-com/ https://www.goodreads.com/work/quotes/18108532-breaking-the-habit-ofbeing-yourself-how-to-lose-your-mind-and-create-a
USER:
What are Joe Dispenza's core teachings?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 21 | 6 | 2,944 | null | 79 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
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I live in California and am trying to understand stand your ground laws. Can you explain it to me? Also, how does it work in my state?
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The common law principle of “castle doctrine” says that individuals have the right to use reasonable force, including deadly force, to protect themselves against an intruder in their home. This principle has been codified and expanded by state legislatures. In the 1980s, a handful of state laws (nicknamed “make my day” laws) addressed immunity from prosecution in use of deadly force against another who unlawfully and forcibly enters a person’s residence. In 2005, Florida passed a law related to castle doctrine, expanding on that premise with “stand your ground” language related to self-defense and duty to retreat. Florida’s law states “a person who is not engaged in an unlawful activity and who is attacked in any other place where he or she has a right to be has no duty to retreat and has the right to stand his or her ground and meet force with force, including deadly force, if he or she reasonably believes it is necessary to do so to prevent death or great bodily harm to himself or herself or another or to prevent the commission of a forcible felony.” Laws in at least 28 states and Puerto Rico allow that there is no duty to retreat an attacker in any place in which one is lawfully present. (Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah and West Virginia Wyoming.) At least ten of those states include language stating one may “stand his or her ground.” (Alabama, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Oklahoma, Pennsylvania and South Carolina.) Eight states (California, Colorado, Illinois, New Mexico, Oregon, Virginia, Vermont and Washington) permit the use of deadly force in self-defense through judicial decisions or jury instructions. Pennsylvania's law, amended in 2011, distinguishes use of deadly force outside one’s home or vehicle. It provides that in such locations one cannot use deadly force unless he has reasonable belief of imminent death or injury, and either he or she cannot retreat in safety or the attacker displays or uses a lethal weapon. Idaho’s law, passed in 2018, expanded the definition of justifiable homicide to include not only defending one’s home against an intruder, but also defending one’s place of employment or an occupied vehicle. Self-defense laws in at least 23 states (Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Montana, New Hampshire, North Carolina, North Dakota, Oklahoma, Ohio, Pennsylvania, South Carolina, Tennessee West Virginia and Wisconsin) provide civil immunity under certain self- defense circumstances. Statutes in at least six states (Hawaii, Missouri, Nebraska, New Jersey, North Dakota and Tennessee) assert that civil remedies are unaffected by criminal provisions of self-defense law. *In 2018, the Ohio House and Senate voted to override the Governor’s veto of House Bill 228. The bill places the burden of disproving a self-defense claim on the prosecution. Additionally, some states (including Arizona, Arkansas, California, Florida, Kansas, Kentucky, Louisiana, Mississippi, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Wisconsin, and Wyoming) have replaced the common law “reasonable person” standard, which placed the burden on the defendant to show that their defensive action were reasonable, with a “presumption of reasonableness,” or “presumption of fear,” which shifts the burden of proof to the prosecutor to prove a negative.
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I live in California and am trying to understand stand your ground laws. Can you explain it to me? Also, how does it work in my state? {passage 0} ========== The common law principle of “castle doctrine” says that individuals have the right to use reasonable force, including deadly force, to protect themselves against an intruder in their home. This principle has been codified and expanded by state legislatures. In the 1980s, a handful of state laws (nicknamed “make my day” laws) addressed immunity from prosecution in use of deadly force against another who unlawfully and forcibly enters a person’s residence. In 2005, Florida passed a law related to castle doctrine, expanding on that premise with “stand your ground” language related to self-defense and duty to retreat. Florida’s law states “a person who is not engaged in an unlawful activity and who is attacked in any other place where he or she has a right to be has no duty to retreat and has the right to stand his or her ground and meet force with force, including deadly force, if he or she reasonably believes it is necessary to do so to prevent death or great bodily harm to himself or herself or another or to prevent the commission of a forcible felony.” Laws in at least 28 states and Puerto Rico allow that there is no duty to retreat an attacker in any place in which one is lawfully present. (Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah and West Virginia Wyoming.) At least ten of those states include language stating one may “stand his or her ground.” (Alabama, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Oklahoma, Pennsylvania and South Carolina.) Eight states (California, Colorado, Illinois, New Mexico, Oregon, Virginia, Vermont and Washington) permit the use of deadly force in self-defense through judicial decisions or jury instructions. Pennsylvania's law, amended in 2011, distinguishes use of deadly force outside one’s home or vehicle. It provides that in such locations one cannot use deadly force unless he has reasonable belief of imminent death or injury, and either he or she cannot retreat in safety or the attacker displays or uses a lethal weapon. Idaho’s law, passed in 2018, expanded the definition of justifiable homicide to include not only defending one’s home against an intruder, but also defending one’s place of employment or an occupied vehicle. Self-defense laws in at least 23 states (Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Montana, New Hampshire, North Carolina, North Dakota, Oklahoma, Ohio, Pennsylvania, South Carolina, Tennessee West Virginia and Wisconsin) provide civil immunity under certain self- defense circumstances. Statutes in at least six states (Hawaii, Missouri, Nebraska, New Jersey, North Dakota and Tennessee) assert that civil remedies are unaffected by criminal provisions of self-defense law. *In 2018, the Ohio House and Senate voted to override the Governor’s veto of House Bill 228. The bill places the burden of disproving a self-defense claim on the prosecution. Additionally, some states (including Arizona, Arkansas, California, Florida, Kansas, Kentucky, Louisiana, Mississippi, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Wisconsin, and Wyoming) have replaced the common law “reasonable person” standard, which placed the burden on the defendant to show that their defensive action were reasonable, with a “presumption of reasonableness,” or “presumption of fear,” which shifts the burden of proof to the prosecutor to prove a negative. https://www.ncsl.org/civil-and-criminal-justice/self-defense-and-stand-your-ground
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
The common law principle of “castle doctrine” says that individuals have the right to use reasonable force, including deadly force, to protect themselves against an intruder in their home. This principle has been codified and expanded by state legislatures. In the 1980s, a handful of state laws (nicknamed “make my day” laws) addressed immunity from prosecution in use of deadly force against another who unlawfully and forcibly enters a person’s residence. In 2005, Florida passed a law related to castle doctrine, expanding on that premise with “stand your ground” language related to self-defense and duty to retreat. Florida’s law states “a person who is not engaged in an unlawful activity and who is attacked in any other place where he or she has a right to be has no duty to retreat and has the right to stand his or her ground and meet force with force, including deadly force, if he or she reasonably believes it is necessary to do so to prevent death or great bodily harm to himself or herself or another or to prevent the commission of a forcible felony.” Laws in at least 28 states and Puerto Rico allow that there is no duty to retreat an attacker in any place in which one is lawfully present. (Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah and West Virginia Wyoming.) At least ten of those states include language stating one may “stand his or her ground.” (Alabama, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Oklahoma, Pennsylvania and South Carolina.) Eight states (California, Colorado, Illinois, New Mexico, Oregon, Virginia, Vermont and Washington) permit the use of deadly force in self-defense through judicial decisions or jury instructions. Pennsylvania's law, amended in 2011, distinguishes use of deadly force outside one’s home or vehicle. It provides that in such locations one cannot use deadly force unless he has reasonable belief of imminent death or injury, and either he or she cannot retreat in safety or the attacker displays or uses a lethal weapon. Idaho’s law, passed in 2018, expanded the definition of justifiable homicide to include not only defending one’s home against an intruder, but also defending one’s place of employment or an occupied vehicle. Self-defense laws in at least 23 states (Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Montana, New Hampshire, North Carolina, North Dakota, Oklahoma, Ohio, Pennsylvania, South Carolina, Tennessee West Virginia and Wisconsin) provide civil immunity under certain self- defense circumstances. Statutes in at least six states (Hawaii, Missouri, Nebraska, New Jersey, North Dakota and Tennessee) assert that civil remedies are unaffected by criminal provisions of self-defense law. *In 2018, the Ohio House and Senate voted to override the Governor’s veto of House Bill 228. The bill places the burden of disproving a self-defense claim on the prosecution. Additionally, some states (including Arizona, Arkansas, California, Florida, Kansas, Kentucky, Louisiana, Mississippi, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Wisconsin, and Wyoming) have replaced the common law “reasonable person” standard, which placed the burden on the defendant to show that their defensive action were reasonable, with a “presumption of reasonableness,” or “presumption of fear,” which shifts the burden of proof to the prosecutor to prove a negative.
USER:
I live in California and am trying to understand stand your ground laws. Can you explain it to me? Also, how does it work in my state?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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You can only answer using from the text provided in the prompt. You can not use any other external resources or prior knowledge. Provide your answer in 5 sentences or less.
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What are families' emotional experiences with a child with rare disease before a diagnosis is received?
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In the absence of correct diagnosis, emergency units are not in a position to treat the patient appropriately, e.g. headache treated as migraine in a neurological emergency unit, whereas a brain tumour is the underlying cause of the pain. Without a diagnosis, when the patient is a child, the family feels particularly guilty because the child is “acting weird” and is not performing normally in terms of mental and psychomotor development. Any abnormal eating behaviour, which accompanies many rare diseases, is frequently blamed on the mother, causing guilt and insecurity. Incomprehension, depression, isolation and anxiety are an intrinsic part of the everyday life of most parents of a child affected by a rare disease, especially in the pre-diagnosis phase. The whole family of a rare disease patient, whether children or adults, is affected by the disease of the loved one and becomes marginalized: psychologically, socially, culturally and economically vulnerable. In many cases, the birth of a child with a rare disease is a cause for parental splitting. Another crucial moment for rare disease patients is the disclosure of diagnosis: despite the progress made over the last ten years, the diagnosis of a rare disease is all too often poorly communicated. Many patients and their families describe the insensitive and uninformative manner in which diagnosis is given. This problem is common among health care practitioners, who are too often neither organised nor trained in good practice for communicating diagnosis. Up to 50% of patients have suffered from poor or unacceptable conditions of disclosure. In order to avoid face-to-face disclosure, doctors often give the terrible diagnosis by phone, in writing - with or even without explanation – or standing in the corridor of a hospital. Training professionals on appropriate ways of disclosure would avoid this additional and unnecessary pain to already anguished patients and 4 More information about the EurordisCare 2 survey can be found on the following websites: http://www.eurordis.org and http://www.rare-luxembourg2005.org/ “Rare Diseases : Understanding this Public Health Priority” 9/14 Eurordis, November 2005 – www.eurordis.org families. Further schooling in “breaking in bad news” to patients constitutes an important aspect of medical training. A father tells: “When I went to pick up my one year-old daughter in the hospital after I had to leave her for many hours of examinations and testing, I anxiously asked the paediatrician what my baby was suffering from. The doctor hardly looked at me and, rushing down the corridor, shouted: “This baby, you better throw her away, and get another child”. Whatever the conditions of disclosure are, the diagnosis of a rare disease means that life is toppling. In order to help rare disease patients and their families face the future and avoid their world collapsing, psychological support is greatly needed. Every mother and father knows how many worries and hopes are involved in having a child. But what it means to be diagnosed - or having a child diagnosed - with a rare disease cannot be explained.
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You can only answer using from the text provided in the prompt. You can not use any other external resources or prior knowledge. Provide your answer in 5 sentences or less. What are families' emotional experiences with a child with rare disease before a diagnosis is received? In the absence of correct diagnosis, emergency units are not in a position to treat the patient appropriately, e.g. headache treated as migraine in a neurological emergency unit, whereas a brain tumour is the underlying cause of the pain. Without a diagnosis, when the patient is a child, the family feels particularly guilty because the child is “acting weird” and is not performing normally in terms of mental and psychomotor development. Any abnormal eating behaviour, which accompanies many rare diseases, is frequently blamed on the mother, causing guilt and insecurity. Incomprehension, depression, isolation and anxiety are an intrinsic part of the everyday life of most parents of a child affected by a rare disease, especially in the pre-diagnosis phase. The whole family of a rare disease patient, whether children or adults, is affected by the disease of the loved one and becomes marginalized: psychologically, socially, culturally and economically vulnerable. In many cases, the birth of a child with a rare disease is a cause for parental splitting. Another crucial moment for rare disease patients is the disclosure of diagnosis: despite the progress made over the last ten years, the diagnosis of a rare disease is all too often poorly communicated. Many patients and their families describe the insensitive and uninformative manner in which diagnosis is given. This problem is common among health care practitioners, who are too often neither organised nor trained in good practice for communicating diagnosis. Up to 50% of patients have suffered from poor or unacceptable conditions of disclosure. In order to avoid face-to-face disclosure, doctors often give the terrible diagnosis by phone, in writing - with or even without explanation – or standing in the corridor of a hospital. Training professionals on appropriate ways of disclosure would avoid this additional and unnecessary pain to already anguished patients and 4 More information about the EurordisCare 2 survey can be found on the following websites: http://www.eurordis.org and http://www.rare-luxembourg2005.org/ “Rare Diseases : Understanding this Public Health Priority” 9/14 Eurordis, November 2005 – www.eurordis.org families. Further schooling in “breaking in bad news” to patients constitutes an important aspect of medical training. A father tells: “When I went to pick up my one year-old daughter in the hospital after I had to leave her for many hours of examinations and testing, I anxiously asked the paediatrician what my baby was suffering from. The doctor hardly looked at me and, rushing down the corridor, shouted: “This baby, you better throw her away, and get another child”. Whatever the conditions of disclosure are, the diagnosis of a rare disease means that life is toppling. In order to help rare disease patients and their families face the future and avoid their world collapsing, psychological support is greatly needed. Every mother and father knows how many worries and hopes are involved in having a child. But what it means to be diagnosed - or having a child diagnosed - with a rare disease cannot be explained.
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You can only answer using from the text provided in the prompt. You can not use any other external resources or prior knowledge. Provide your answer in 5 sentences or less.
EVIDENCE:
In the absence of correct diagnosis, emergency units are not in a position to treat the patient appropriately, e.g. headache treated as migraine in a neurological emergency unit, whereas a brain tumour is the underlying cause of the pain. Without a diagnosis, when the patient is a child, the family feels particularly guilty because the child is “acting weird” and is not performing normally in terms of mental and psychomotor development. Any abnormal eating behaviour, which accompanies many rare diseases, is frequently blamed on the mother, causing guilt and insecurity. Incomprehension, depression, isolation and anxiety are an intrinsic part of the everyday life of most parents of a child affected by a rare disease, especially in the pre-diagnosis phase. The whole family of a rare disease patient, whether children or adults, is affected by the disease of the loved one and becomes marginalized: psychologically, socially, culturally and economically vulnerable. In many cases, the birth of a child with a rare disease is a cause for parental splitting. Another crucial moment for rare disease patients is the disclosure of diagnosis: despite the progress made over the last ten years, the diagnosis of a rare disease is all too often poorly communicated. Many patients and their families describe the insensitive and uninformative manner in which diagnosis is given. This problem is common among health care practitioners, who are too often neither organised nor trained in good practice for communicating diagnosis. Up to 50% of patients have suffered from poor or unacceptable conditions of disclosure. In order to avoid face-to-face disclosure, doctors often give the terrible diagnosis by phone, in writing - with or even without explanation – or standing in the corridor of a hospital. Training professionals on appropriate ways of disclosure would avoid this additional and unnecessary pain to already anguished patients and 4 More information about the EurordisCare 2 survey can be found on the following websites: http://www.eurordis.org and http://www.rare-luxembourg2005.org/ “Rare Diseases : Understanding this Public Health Priority” 9/14 Eurordis, November 2005 – www.eurordis.org families. Further schooling in “breaking in bad news” to patients constitutes an important aspect of medical training. A father tells: “When I went to pick up my one year-old daughter in the hospital after I had to leave her for many hours of examinations and testing, I anxiously asked the paediatrician what my baby was suffering from. The doctor hardly looked at me and, rushing down the corridor, shouted: “This baby, you better throw her away, and get another child”. Whatever the conditions of disclosure are, the diagnosis of a rare disease means that life is toppling. In order to help rare disease patients and their families face the future and avoid their world collapsing, psychological support is greatly needed. Every mother and father knows how many worries and hopes are involved in having a child. But what it means to be diagnosed - or having a child diagnosed - with a rare disease cannot be explained.
USER:
What are families' emotional experiences with a child with rare disease before a diagnosis is received?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 31 | 16 | 491 | null | 552 |
Respond using only information in the context block provided. Do not use any acronyms in your response.
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List every influence of the pandemic in a bullet list, using only three sentences for each point.
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One of the main ways in which the economy impacts CRE is via interest rates. Higher interest rates in both the short term and the long term are likely to affect industries that rely on credit, such as CRE.6 Tighter credit conditions can affect the ability of builders to obtain financing for new construction. Higher borrowing costs can in turn reduce CRE growth or increase rents for CRE occupants. If CRE owners ultimately cannot make payments on higher cost loans, this could result in losses for those individuals and institutions that finance CRE. In recent years, interest rates rose significantly, one of several fundamental shifts in the economic environment. Prior to the pandemic, inflation was low and stable despite over a decade of historically low interest rates and accommodative monetary policy.7 This led to low borrowing costs. However, inflation began rising in 2021, reaching highs not seen since the 1980s, and interest rates have also risen significantly. In response to inflation, the Federal Reserve (Fed) raised the federal funds rate (FFR) over five percentage points between March 2022 and July 2023.8 Other interest rates in the economy responded to the Fed’s actions, resulting in a higher interest rate environment and higher borrowing costs. The Fed has yet to begin lowering rates but is expected to begin lowering rates in late 2024. The Fed projects that the appropriate monetary policy path will result in an FFR of 2.8% in the longer run—relatively low in historical terms but higher than most of the period since the 2007-2009 financial crisis and recession.9 CRE is also likely to be affected by other economic conditions, including demand and investment behavior. Despite the Fed’s efforts to reduce demand through interest rate hikes, the economy has remained unexpectedly robust in the face of monetary tightening particularly with respect to metrics that could affect CRE, such as consumer spending and labor market conditions. While monetary tightening has weighed somewhat on investment, including residential investment (which includes multifamily CRE properties), consumer spending has been strong, which could help retail CRE properties. Overall, the labor market closed out 2023 relatively strong with unemployment at 3.7%, and economic growth largely beat expectations in 2023 at 2.5% for the year. 10 While the first quarter of 2024 did show an increase in the unemployment rate, higher than-anticipated inflation, and slower growth, the economy remains in relatively good condition, with growth at a strong 3.0% in the second quarter. A continued strong economic performance could help buoy CRE markets despite higher borrowing costs. Economic Outlook for CRE Since the Fed began raising rates in response to high inflation in March 2022, it has been trying to achieve a soft landing—a return to low inflation while maintaining moderate economic growth and full employment.11 Achieving a soft landing after sustained monetary policy tightening is notoriously difficult. Historically, most periods of sustained tightening have been followed by hard landings, meaning recessions. Nonetheless, the recent period of monetary policy tightening has so far resulted in falling inflation without a significant decline in employment or economic activity. A soft landing would be advantageous to CRE, as it would be to all sectors of the economy. All else equal, low and stable inflation, moderate growth, and a strong labor market would lead to robust and sustainable demand, including consumer spending and business investment. A hard landing would lead to lower demand and likely lower CRE growth. In terms of CRE, the path of interest rates may be of particular policy interest given the role they play in CRE. In the projected scenario of a soft landing, interest rates are likely to decrease beginning this year. As of June 2024, the Fed’s Federal Open Market Committee projected that one rate decrease in the second half of 2024 would be appropriate, with the median projected appropriate policy path resulting in an FFR of 5.1% at the end of 2024, 4.1% at the end of 2025, and 3.1% at the end of 2026.12 In August 2024, Fed Chair Jerome Powell stated that “the time has come for policy to adjust,” indicating likely rate cuts beginning in September 2024.13 However, changes in the FFR are unlikely to affect longer-term interest rates by the same magnitude. For example, an Organisation for Economic Co-operation and Development model for long-term interest rates forecasts that the rate on a 10-year government security will be 3.9% in the third quarter of 2025.14 The yield on a 10-year Treasury as of July 2, 2024, was 4.43%.15 Easing credit conditions could boost construction and CRE growth generally, although there is a high degree of uncertainty about how much interest rates will ultimately fall. While most economists are not predicting an imminent recession, it is possible that one could occur nonetheless. For example, the recent increases in the unemployment rate have some concerned that the economy is weakening.16 In this scenario, the Fed may opt to lower the FFR either more quickly or by a larger magnitude than it may otherwise have done. Such an economic contraction would likely hurt CRE growth, but the monetary response would help it to recover, all else equal. Structural Changes Affecting CRE Properties While certain broad economic conditions may be expected to affect CRE broadly, the impacts can look quite different based on type. For example, COVID-19 was a shock to all CRE segments as well as the broader economy. However, based on the nature of the pandemic, demand for office or retail space took relatively big hits, as restrictions on in-person contact made spending in brick and-mortar stores difficult and resulted in increased telework. 17 While the performance of CRE sectors has largely been mixed, the office sector in particular is continuing to show signs of stress and has the highest potential to cause stress in the banking sector. For example, while vacancy rates are up since pre-pandemic for multifamily and retail, they are elevated to a lesser degree than in the office sector, which shows record-level vacancy rates. In the industrial sector, vacancy rates have fallen since the beginning of the pandemic. Other metrics, such as rents, tell a less consistent story across sectors over this period. Nonetheless, as of the second quarter of 2024, quarterly effective rent growth was positive in all sectors apart from office.18 The Office Sector The pandemic resulted in a structural shift away from in-office work, resulting in high vacancy rates for this segment of CRE that persist today. With the rise in telework, many companies renting space from the office subsector of CRE owners are not renewing their leases. This is evidenced by higher office vacancy rates (see Figure 1), which continue to rise, hitting a record 20.1% in the second quarter of 2024, according to Moody’s Analytics, a credit rating agency. 19 Consequently, the number of office property rental leases has declined, generating lower revenues and potentially imperiling the ability of the property owners to pay back financing costs. According to Moody’s, effective rents have been negative or largely unchanged for the four quarters ending in Q2 2024 (see Figure 1).20 To minimize losses, some CRE owners have been willing to break leases and renegotiate terms with tenants. 21 Further, while norms surrounding remote and hybrid work have shifted in the past few years owing to the COVID-19 pandemic, the extent to which remote work will shift the CRE landscape is uncertain. While rates of office utilization are lower than prior to the pandemic (i.e., February 2020), according to some estimates, they have, on average, trended upward in selected major cities after the initial onset (i.e., March 2020) of the pandemic (see Figure 2).
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System instruction: [Respond using only information in the context block provided. Do not use any acronyms in your response.] User question: [List every influence of the pandemic in a bullet list, using only three sentences for each point.] Context block: [One of the main ways in which the economy impacts CRE is via interest rates. Higher interest rates in both the short term and the long term are likely to affect industries that rely on credit, such as CRE.6 Tighter credit conditions can affect the ability of builders to obtain financing for new construction. Higher borrowing costs can in turn reduce CRE growth or increase rents for CRE occupants. If CRE owners ultimately cannot make payments on higher cost loans, this could result in losses for those individuals and institutions that finance CRE. In recent years, interest rates rose significantly, one of several fundamental shifts in the economic environment. Prior to the pandemic, inflation was low and stable despite over a decade of historically low interest rates and accommodative monetary policy.7 This led to low borrowing costs. However, inflation began rising in 2021, reaching highs not seen since the 1980s, and interest rates have also risen significantly. In response to inflation, the Federal Reserve (Fed) raised the federal funds rate (FFR) over five percentage points between March 2022 and July 2023.8 Other interest rates in the economy responded to the Fed’s actions, resulting in a higher interest rate environment and higher borrowing costs. The Fed has yet to begin lowering rates but is expected to begin lowering rates in late 2024. The Fed projects that the appropriate monetary policy path will result in an FFR of 2.8% in the longer run—relatively low in historical terms but higher than most of the period since the 2007-2009 financial crisis and recession.9 CRE is also likely to be affected by other economic conditions, including demand and investment behavior. Despite the Fed’s efforts to reduce demand through interest rate hikes, the economy has remained unexpectedly robust in the face of monetary tightening particularly with respect to metrics that could affect CRE, such as consumer spending and labor market conditions. While monetary tightening has weighed somewhat on investment, including residential investment (which includes multifamily CRE properties), consumer spending has been strong, which could help retail CRE properties. Overall, the labor market closed out 2023 relatively strong with unemployment at 3.7%, and economic growth largely beat expectations in 2023 at 2.5% for the year. 10 While the first quarter of 2024 did show an increase in the unemployment rate, higher than-anticipated inflation, and slower growth, the economy remains in relatively good condition, with growth at a strong 3.0% in the second quarter. A continued strong economic performance could help buoy CRE markets despite higher borrowing costs. Economic Outlook for CRE Since the Fed began raising rates in response to high inflation in March 2022, it has been trying to achieve a soft landing—a return to low inflation while maintaining moderate economic growth and full employment.11 Achieving a soft landing after sustained monetary policy tightening is notoriously difficult. Historically, most periods of sustained tightening have been followed by hard landings, meaning recessions. Nonetheless, the recent period of monetary policy tightening has so far resulted in falling inflation without a significant decline in employment or economic activity. A soft landing would be advantageous to CRE, as it would be to all sectors of the economy. All else equal, low and stable inflation, moderate growth, and a strong labor market would lead to robust and sustainable demand, including consumer spending and business investment. A hard landing would lead to lower demand and likely lower CRE growth. In terms of CRE, the path of interest rates may be of particular policy interest given the role they play in CRE. In the projected scenario of a soft landing, interest rates are likely to decrease beginning this year. As of June 2024, the Fed’s Federal Open Market Committee projected that one rate decrease in the second half of 2024 would be appropriate, with the median projected appropriate policy path resulting in an FFR of 5.1% at the end of 2024, 4.1% at the end of 2025, and 3.1% at the end of 2026.12 In August 2024, Fed Chair Jerome Powell stated that “the time has come for policy to adjust,” indicating likely rate cuts beginning in September 2024.13 However, changes in the FFR are unlikely to affect longer-term interest rates by the same magnitude. For example, an Organisation for Economic Co-operation and Development model for long-term interest rates forecasts that the rate on a 10-year government security will be 3.9% in the third quarter of 2025.14 The yield on a 10-year Treasury as of July 2, 2024, was 4.43%.15 Easing credit conditions could boost construction and CRE growth generally, although there is a high degree of uncertainty about how much interest rates will ultimately fall. While most economists are not predicting an imminent recession, it is possible that one could occur nonetheless. For example, the recent increases in the unemployment rate have some concerned that the economy is weakening.16 In this scenario, the Fed may opt to lower the FFR either more quickly or by a larger magnitude than it may otherwise have done. Such an economic contraction would likely hurt CRE growth, but the monetary response would help it to recover, all else equal. Structural Changes Affecting CRE Properties While certain broad economic conditions may be expected to affect CRE broadly, the impacts can look quite different based on type. For example, COVID-19 was a shock to all CRE segments as well as the broader economy. However, based on the nature of the pandemic, demand for office or retail space took relatively big hits, as restrictions on in-person contact made spending in brick and-mortar stores difficult and resulted in increased telework. 17 While the performance of CRE sectors has largely been mixed, the office sector in particular is continuing to show signs of stress and has the highest potential to cause stress in the banking sector. For example, while vacancy rates are up since pre-pandemic for multifamily and retail, they are elevated to a lesser degree than in the office sector, which shows record-level vacancy rates. In the industrial sector, vacancy rates have fallen since the beginning of the pandemic. Other metrics, such as rents, tell a less consistent story across sectors over this period. Nonetheless, as of the second quarter of 2024, quarterly effective rent growth was positive in all sectors apart from office.18 The Office Sector The pandemic resulted in a structural shift away from in-office work, resulting in high vacancy rates for this segment of CRE that persist today. With the rise in telework, many companies renting space from the office subsector of CRE owners are not renewing their leases. This is evidenced by higher office vacancy rates (see Figure 1), which continue to rise, hitting a record 20.1% in the second quarter of 2024, according to Moody’s Analytics, a credit rating agency. 19 Consequently, the number of office property rental leases has declined, generating lower revenues and potentially imperiling the ability of the property owners to pay back financing costs. According to Moody’s, effective rents have been negative or largely unchanged for the four quarters ending in Q2 2024 (see Figure 1).20 To minimize losses, some CRE owners have been willing to break leases and renegotiate terms with tenants. 21 Further, while norms surrounding remote and hybrid work have shifted in the past few years owing to the COVID-19 pandemic, the extent to which remote work will shift the CRE landscape is uncertain. While rates of office utilization are lower than prior to the pandemic (i.e., February 2020), according to some estimates, they have, on average, trended upward in selected major cities after the initial onset (i.e., March 2020) of the pandemic (see Figure 2).]
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Respond using only information in the context block provided. Do not use any acronyms in your response.
EVIDENCE:
One of the main ways in which the economy impacts CRE is via interest rates. Higher interest rates in both the short term and the long term are likely to affect industries that rely on credit, such as CRE.6 Tighter credit conditions can affect the ability of builders to obtain financing for new construction. Higher borrowing costs can in turn reduce CRE growth or increase rents for CRE occupants. If CRE owners ultimately cannot make payments on higher cost loans, this could result in losses for those individuals and institutions that finance CRE. In recent years, interest rates rose significantly, one of several fundamental shifts in the economic environment. Prior to the pandemic, inflation was low and stable despite over a decade of historically low interest rates and accommodative monetary policy.7 This led to low borrowing costs. However, inflation began rising in 2021, reaching highs not seen since the 1980s, and interest rates have also risen significantly. In response to inflation, the Federal Reserve (Fed) raised the federal funds rate (FFR) over five percentage points between March 2022 and July 2023.8 Other interest rates in the economy responded to the Fed’s actions, resulting in a higher interest rate environment and higher borrowing costs. The Fed has yet to begin lowering rates but is expected to begin lowering rates in late 2024. The Fed projects that the appropriate monetary policy path will result in an FFR of 2.8% in the longer run—relatively low in historical terms but higher than most of the period since the 2007-2009 financial crisis and recession.9 CRE is also likely to be affected by other economic conditions, including demand and investment behavior. Despite the Fed’s efforts to reduce demand through interest rate hikes, the economy has remained unexpectedly robust in the face of monetary tightening particularly with respect to metrics that could affect CRE, such as consumer spending and labor market conditions. While monetary tightening has weighed somewhat on investment, including residential investment (which includes multifamily CRE properties), consumer spending has been strong, which could help retail CRE properties. Overall, the labor market closed out 2023 relatively strong with unemployment at 3.7%, and economic growth largely beat expectations in 2023 at 2.5% for the year. 10 While the first quarter of 2024 did show an increase in the unemployment rate, higher than-anticipated inflation, and slower growth, the economy remains in relatively good condition, with growth at a strong 3.0% in the second quarter. A continued strong economic performance could help buoy CRE markets despite higher borrowing costs. Economic Outlook for CRE Since the Fed began raising rates in response to high inflation in March 2022, it has been trying to achieve a soft landing—a return to low inflation while maintaining moderate economic growth and full employment.11 Achieving a soft landing after sustained monetary policy tightening is notoriously difficult. Historically, most periods of sustained tightening have been followed by hard landings, meaning recessions. Nonetheless, the recent period of monetary policy tightening has so far resulted in falling inflation without a significant decline in employment or economic activity. A soft landing would be advantageous to CRE, as it would be to all sectors of the economy. All else equal, low and stable inflation, moderate growth, and a strong labor market would lead to robust and sustainable demand, including consumer spending and business investment. A hard landing would lead to lower demand and likely lower CRE growth. In terms of CRE, the path of interest rates may be of particular policy interest given the role they play in CRE. In the projected scenario of a soft landing, interest rates are likely to decrease beginning this year. As of June 2024, the Fed’s Federal Open Market Committee projected that one rate decrease in the second half of 2024 would be appropriate, with the median projected appropriate policy path resulting in an FFR of 5.1% at the end of 2024, 4.1% at the end of 2025, and 3.1% at the end of 2026.12 In August 2024, Fed Chair Jerome Powell stated that “the time has come for policy to adjust,” indicating likely rate cuts beginning in September 2024.13 However, changes in the FFR are unlikely to affect longer-term interest rates by the same magnitude. For example, an Organisation for Economic Co-operation and Development model for long-term interest rates forecasts that the rate on a 10-year government security will be 3.9% in the third quarter of 2025.14 The yield on a 10-year Treasury as of July 2, 2024, was 4.43%.15 Easing credit conditions could boost construction and CRE growth generally, although there is a high degree of uncertainty about how much interest rates will ultimately fall. While most economists are not predicting an imminent recession, it is possible that one could occur nonetheless. For example, the recent increases in the unemployment rate have some concerned that the economy is weakening.16 In this scenario, the Fed may opt to lower the FFR either more quickly or by a larger magnitude than it may otherwise have done. Such an economic contraction would likely hurt CRE growth, but the monetary response would help it to recover, all else equal. Structural Changes Affecting CRE Properties While certain broad economic conditions may be expected to affect CRE broadly, the impacts can look quite different based on type. For example, COVID-19 was a shock to all CRE segments as well as the broader economy. However, based on the nature of the pandemic, demand for office or retail space took relatively big hits, as restrictions on in-person contact made spending in brick and-mortar stores difficult and resulted in increased telework. 17 While the performance of CRE sectors has largely been mixed, the office sector in particular is continuing to show signs of stress and has the highest potential to cause stress in the banking sector. For example, while vacancy rates are up since pre-pandemic for multifamily and retail, they are elevated to a lesser degree than in the office sector, which shows record-level vacancy rates. In the industrial sector, vacancy rates have fallen since the beginning of the pandemic. Other metrics, such as rents, tell a less consistent story across sectors over this period. Nonetheless, as of the second quarter of 2024, quarterly effective rent growth was positive in all sectors apart from office.18 The Office Sector The pandemic resulted in a structural shift away from in-office work, resulting in high vacancy rates for this segment of CRE that persist today. With the rise in telework, many companies renting space from the office subsector of CRE owners are not renewing their leases. This is evidenced by higher office vacancy rates (see Figure 1), which continue to rise, hitting a record 20.1% in the second quarter of 2024, according to Moody’s Analytics, a credit rating agency. 19 Consequently, the number of office property rental leases has declined, generating lower revenues and potentially imperiling the ability of the property owners to pay back financing costs. According to Moody’s, effective rents have been negative or largely unchanged for the four quarters ending in Q2 2024 (see Figure 1).20 To minimize losses, some CRE owners have been willing to break leases and renegotiate terms with tenants. 21 Further, while norms surrounding remote and hybrid work have shifted in the past few years owing to the COVID-19 pandemic, the extent to which remote work will shift the CRE landscape is uncertain. While rates of office utilization are lower than prior to the pandemic (i.e., February 2020), according to some estimates, they have, on average, trended upward in selected major cities after the initial onset (i.e., March 2020) of the pandemic (see Figure 2).
USER:
List every influence of the pandemic in a bullet list, using only three sentences for each point.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 17 | 17 | 1,268 | null | 47 |
You must respond using only information provided in the prompt. Explain your reasoning with at least 3 supporting points.
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What is the probable date range for this document
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The main challenges are, if such divergence simply reflects differences in financial market structures and regulatory/supervisory tools and instruments as well as with a principles-based approach, or a IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 46 more fundamental shift towards a less regulated financial system that focuses on growth and ‘competitiveness’ of the sector and less on its stability. It is important to stress, however, that not all observers, and none of our interviewees, see necessarily a contradiction between growth/competitiveness and stability, even though economic research has shown that rapid growth of the financial sector can result in financial fragility and crisis. 3.2.1. Low, medium and high divergence Low divergence: Under this scenario, there will be adjustments to regulations such as Solvency II as well as other initiatives in line with increasing the ‘competitiveness’ of the UK as financial centre. However, there will not be major divergence, especially in areas with international standards, such as bank capital regulation. There might be informal consultations between UK and EU regulatory and possibly legislative authorities to converge on rules in new areas such as crypto and the decentralised financial system more generally. Even under the politically most positive developments (as described below in 3.2.2), however, there will be divergence between the UK and EU, also as EU Law is significantly amended with the UK not following it (in other words, passive divergence). Regulatory cooperation, however, will allow for such divergence not to turn into beggar-thy-neighbour policies. Apart from resolving the political conflict around the Northern Ireland Protocol (NIP), a reconfirmation of the stability focus of the prudential policies and regulation in the UK is necessary in our opinion. In terms of specific segments of the financial system, we would expect least divergence in areas where international standards play an important role, such as capital and liquidity regulation of banks. Interestingly, it seems that the EU is diverging more from the initial global standards than the UK (see discussion above in 3.1). Similarly, given the early initiative that EU authorities have taken with the green taxonomy and the joint participation in many global fora and other cooperation initiatives, we would also expect the UK to follow the lead in this area, as already discussed above, even though there might be a certain degree of divergence. It is important to stress that many of the legislative initiatives in sustainable finance in the UK are still in the early stages and one has to look beyond political headlines to details once they are spelled out. Medium divergence: Under this scenario, there will be more significant divergence and fewer attempts to converge on new rules such as in the area of green finance or crypto asset developments. Divergence will be more likely and more prominent in areas where international standards are less important and where the UK has not inherited any EU regulations such as in the two areas already mentioned, green finance and crypto. While supervisory cooperation between EU and UK authorities might continue (and will be necessary in areas of regulatory equivalence), regulatory cooperation even if formalised will be less strong and there will not necessarily be any voluntary attempt by UK authorities to follow adjustments and changes in EU regulation and supervision. On the other hand, both the UK and the EU are members of global regulatory bodies across different segments of the financial system (FSB, Basel Committee) and this will effectively be a constraint on too much positive or negative divergence. High divergence: Under this final scenario, there would be a rather aggressive legislative and regulatory drive in the UK to diverge from EU rules. This would involve both replacing existing EU rules with new regulation and adopting divergent rules where such rules were not inherited, such as in green finance and crypto/digital finance more broadly. It can also include not following changes in EU legislation to thus mark differences between the two regulatory jurisdictions. We would expect such aggressive divergence especially in areas where UK authorities see growth opportunities and they feel less constrained by international fora and cooperation initiatives. Crypto is certainly an area where one could envision such aggressive divergence. Such high divergence, however, seems more likely under Recent trends in UK financial sector regulation and possible implications for the EU 47 PE 740.067 an institutional architecture in the UK where the independence of regulatory authorities has been significantly weakened (though not necessarily in a formal, i.e., legislative manner) and growth/competitiveness objectives are clearly prioritised over stability concerns. As we will discuss in section 3.2.2, which of the three scenarios will develop depends very much on how the overall political relationship between the EU and the UK will develop over the next years, with the Northern Ireland Protocol being the major hurdle in this relationship. 3.2.2. Disentangling the Northern Ireland Protocol situation to unblock/reactivate UKEU regulatory cooperation Resolving the dispute between the UK and the EU on the implementation of the Northern Ireland Protocol (NIP) seems key to rebuild trust and unblock UK-EU regulatory cooperation across a number of policy areas including the financial sector. Resolving this dispute requires political leadership from the UK Prime Minister taking office in October 2022, Rishi Sunak, and bringing on board both the European Research Group (ERG) of hardcore Brexiters in the British Parliament and Northern Ireland’s Unionists, not an easy feat. While immediate conflicts can be avoided by delaying the legislative process of the NIP Bill (which would override and breach the NIP and the Withdrawal Agreement), cooperation between UK and EU authorities on trade data provision from the UK to the EU, and not taking unilateral steps, the resolution of the ‘stand-off’ cannot be delayed forever. Namely, the Northern Ireland Executive has not been established since the 2022 May elections and new elections to the Legislative Assembly will have to be called in spring 2023, which raise the political temperature in the region. The upcoming 25th anniversary of the Good Friday Agreement in 2023 increases both internal and external (especially from the US) pressures. Finally, in case of increasing divergence in goods standards between the UK and the EU, there will be increasing pressure from the EU on properly monitoring trade between Great Britain and Northern Ireland. In case the conflict around the Northern Ireland Protocol can be resolved to the satisfaction of both sides, there should be few if any barriers for future cooperation between UK and EU authorities on financial sector issues. Addressing the stand-off around the NIP is thus a necessary though not sufficient condition. At the end of November 2022, the Council Presidency and the European Parliament actually reached a provisional agreement on a Regulation on ‘autonomous measures’ potentially taken as a retaliation and that would allow the EU to ensure ‘timely and effective exercise of its rights in enforcing and implementing’ the Withdrawal Agreement and the TCA162. At the same time, not long after, the European Commission Vice President Maroš Šefčovič stressed the ‘window of opportunity for a positive outcome’163 in the context of the extension of practical arrangements for veterinary medicines until December 2025. This positive ‘mood music’ has been echoed by Leo Varadkar, the Taoiseach in Ireland, who stressed the increased trust and flexibility between the UK and the EU – notwithstanding remaining differences164. There will certainly be competing interests (similar to what we could observe during the UK’s EU membership) and no expectations of complete convergence, but an institutional framework for regulatory dialogue could be put in place. 162 Council of the EU, ‘EU-UK Relations: Council Presidency and European Parliament Reach Provisional Agreement on a Regulation on Autonomous Measures’ (30 November 2022) https://www.consilium.europa.eu/en/press/press-releases/2022/11/30/eu-uk-relationscouncil-presidency-and-european-parliament-reach-provisional-agreement-on-a-regulation-on-autonomous-measures/, accessed 5 January 2023. 163 ‘Statement by Vice-President Maroš Šefčovič’ (European Commission, 19 December 2022) https://ec.europa.eu/commission/presscorner/detail/en/statement_22_7831, accessed 5 January 2023. 164 “Much Better Mood Music” in EU-UK Relations than at Any Period since Brexit Referendum - Taoiseach’ (n 22). IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 48 Before the resolution of this conflict, it is difficult to see any progress happening in terms of regulatory cooperation. Similar, if the conflict around the NIP escalates again, it is hard to envision any progress towards trade partnership of the UK with third countries such as the US.
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You must respond using only information provided in the prompt. Explain your reasoning with at least 3 supporting points. The main challenges are, if such divergence simply reflects differences in financial market structures and regulatory/supervisory tools and instruments as well as with a principles-based approach, or a IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 46 more fundamental shift towards a less regulated financial system that focuses on growth and ‘competitiveness’ of the sector and less on its stability. It is important to stress, however, that not all observers, and none of our interviewees, see necessarily a contradiction between growth/competitiveness and stability, even though economic research has shown that rapid growth of the financial sector can result in financial fragility and crisis. 3.2.1. Low, medium and high divergence Low divergence: Under this scenario, there will be adjustments to regulations such as Solvency II as well as other initiatives in line with increasing the ‘competitiveness’ of the UK as financial centre. However, there will not be major divergence, especially in areas with international standards, such as bank capital regulation. There might be informal consultations between UK and EU regulatory and possibly legislative authorities to converge on rules in new areas such as crypto and the decentralised financial system more generally. Even under the politically most positive developments (as described below in 3.2.2), however, there will be divergence between the UK and EU, also as EU Law is significantly amended with the UK not following it (in other words, passive divergence). Regulatory cooperation, however, will allow for such divergence not to turn into beggar-thy-neighbour policies. Apart from resolving the political conflict around the Northern Ireland Protocol (NIP), a reconfirmation of the stability focus of the prudential policies and regulation in the UK is necessary in our opinion. In terms of specific segments of the financial system, we would expect least divergence in areas where international standards play an important role, such as capital and liquidity regulation of banks. Interestingly, it seems that the EU is diverging more from the initial global standards than the UK (see discussion above in 3.1). Similarly, given the early initiative that EU authorities have taken with the green taxonomy and the joint participation in many global fora and other cooperation initiatives, we would also expect the UK to follow the lead in this area, as already discussed above, even though there might be a certain degree of divergence. It is important to stress that many of the legislative initiatives in sustainable finance in the UK are still in the early stages and one has to look beyond political headlines to details once they are spelled out. Medium divergence: Under this scenario, there will be more significant divergence and fewer attempts to converge on new rules such as in the area of green finance or crypto asset developments. Divergence will be more likely and more prominent in areas where international standards are less important and where the UK has not inherited any EU regulations such as in the two areas already mentioned, green finance and crypto. While supervisory cooperation between EU and UK authorities might continue (and will be necessary in areas of regulatory equivalence), regulatory cooperation even if formalised will be less strong and there will not necessarily be any voluntary attempt by UK authorities to follow adjustments and changes in EU regulation and supervision. On the other hand, both the UK and the EU are members of global regulatory bodies across different segments of the financial system (FSB, Basel Committee) and this will effectively be a constraint on too much positive or negative divergence. High divergence: Under this final scenario, there would be a rather aggressive legislative and regulatory drive in the UK to diverge from EU rules. This would involve both replacing existing EU rules with new regulation and adopting divergent rules where such rules were not inherited, such as in green finance and crypto/digital finance more broadly. It can also include not following changes in EU legislation to thus mark differences between the two regulatory jurisdictions. We would expect such aggressive divergence especially in areas where UK authorities see growth opportunities and they feel less constrained by international fora and cooperation initiatives. Crypto is certainly an area where one could envision such aggressive divergence. Such high divergence, however, seems more likely under Recent trends in UK financial sector regulation and possible implications for the EU 47 PE 740.067 an institutional architecture in the UK where the independence of regulatory authorities has been significantly weakened (though not necessarily in a formal, i.e., legislative manner) and growth/competitiveness objectives are clearly prioritised over stability concerns. As we will discuss in section 3.2.2, which of the three scenarios will develop depends very much on how the overall political relationship between the EU and the UK will develop over the next years, with the Northern Ireland Protocol being the major hurdle in this relationship. 3.2.2. Disentangling the Northern Ireland Protocol situation to unblock/reactivate UKEU regulatory cooperation Resolving the dispute between the UK and the EU on the implementation of the Northern Ireland Protocol (NIP) seems key to rebuild trust and unblock UK-EU regulatory cooperation across a number of policy areas including the financial sector. Resolving this dispute requires political leadership from the UK Prime Minister taking office in October 2022, Rishi Sunak, and bringing on board both the European Research Group (ERG) of hardcore Brexiters in the British Parliament and Northern Ireland’s Unionists, not an easy feat. While immediate conflicts can be avoided by delaying the legislative process of the NIP Bill (which would override and breach the NIP and the Withdrawal Agreement), cooperation between UK and EU authorities on trade data provision from the UK to the EU, and not taking unilateral steps, the resolution of the ‘stand-off’ cannot be delayed forever. Namely, the Northern Ireland Executive has not been established since the 2022 May elections and new elections to the Legislative Assembly will have to be called in spring 2023, which raise the political temperature in the region. The upcoming 25th anniversary of the Good Friday Agreement in 2023 increases both internal and external (especially from the US) pressures. Finally, in case of increasing divergence in goods standards between the UK and the EU, there will be increasing pressure from the EU on properly monitoring trade between Great Britain and Northern Ireland. In case the conflict around the Northern Ireland Protocol can be resolved to the satisfaction of both sides, there should be few if any barriers for future cooperation between UK and EU authorities on financial sector issues. Addressing the stand-off around the NIP is thus a necessary though not sufficient condition. At the end of November 2022, the Council Presidency and the European Parliament actually reached a provisional agreement on a Regulation on ‘autonomous measures’ potentially taken as a retaliation and that would allow the EU to ensure ‘timely and effective exercise of its rights in enforcing and implementing’ the Withdrawal Agreement and the TCA162. At the same time, not long after, the European Commission Vice President Maroš Šefčovič stressed the ‘window of opportunity for a positive outcome’163 in the context of the extension of practical arrangements for veterinary medicines until December 2025. This positive ‘mood music’ has been echoed by Leo Varadkar, the Taoiseach in Ireland, who stressed the increased trust and flexibility between the UK and the EU – notwithstanding remaining differences164. There will certainly be competing interests (similar to what we could observe during the UK’s EU membership) and no expectations of complete convergence, but an institutional framework for regulatory dialogue could be put in place. 162 Council of the EU, ‘EU-UK Relations: Council Presidency and European Parliament Reach Provisional Agreement on a Regulation on Autonomous Measures’ (30 November 2022) https://www.consilium.europa.eu/en/press/press-releases/2022/11/30/eu-uk-relationscouncil-presidency-and-european-parliament-reach-provisional-agreement-on-a-regulation-on-autonomous-measures/, accessed 5 January 2023. 163 ‘Statement by Vice-President Maroš Šefčovič’ (European Commission, 19 December 2022) https://ec.europa.eu/commission/presscorner/detail/en/statement_22_7831, accessed 5 January 2023. 164 “Much Better Mood Music” in EU-UK Relations than at Any Period since Brexit Referendum - Taoiseach’ (n 22). IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 48 Before the resolution of this conflict, it is difficult to see any progress happening in terms of regulatory cooperation. Similar, if the conflict around the NIP escalates again, it is hard to envision any progress towards trade partnership of the UK with third countries such as the US. What is the probable date range for this document
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You must respond using only information provided in the prompt. Explain your reasoning with at least 3 supporting points.
EVIDENCE:
The main challenges are, if such divergence simply reflects differences in financial market structures and regulatory/supervisory tools and instruments as well as with a principles-based approach, or a IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 46 more fundamental shift towards a less regulated financial system that focuses on growth and ‘competitiveness’ of the sector and less on its stability. It is important to stress, however, that not all observers, and none of our interviewees, see necessarily a contradiction between growth/competitiveness and stability, even though economic research has shown that rapid growth of the financial sector can result in financial fragility and crisis. 3.2.1. Low, medium and high divergence Low divergence: Under this scenario, there will be adjustments to regulations such as Solvency II as well as other initiatives in line with increasing the ‘competitiveness’ of the UK as financial centre. However, there will not be major divergence, especially in areas with international standards, such as bank capital regulation. There might be informal consultations between UK and EU regulatory and possibly legislative authorities to converge on rules in new areas such as crypto and the decentralised financial system more generally. Even under the politically most positive developments (as described below in 3.2.2), however, there will be divergence between the UK and EU, also as EU Law is significantly amended with the UK not following it (in other words, passive divergence). Regulatory cooperation, however, will allow for such divergence not to turn into beggar-thy-neighbour policies. Apart from resolving the political conflict around the Northern Ireland Protocol (NIP), a reconfirmation of the stability focus of the prudential policies and regulation in the UK is necessary in our opinion. In terms of specific segments of the financial system, we would expect least divergence in areas where international standards play an important role, such as capital and liquidity regulation of banks. Interestingly, it seems that the EU is diverging more from the initial global standards than the UK (see discussion above in 3.1). Similarly, given the early initiative that EU authorities have taken with the green taxonomy and the joint participation in many global fora and other cooperation initiatives, we would also expect the UK to follow the lead in this area, as already discussed above, even though there might be a certain degree of divergence. It is important to stress that many of the legislative initiatives in sustainable finance in the UK are still in the early stages and one has to look beyond political headlines to details once they are spelled out. Medium divergence: Under this scenario, there will be more significant divergence and fewer attempts to converge on new rules such as in the area of green finance or crypto asset developments. Divergence will be more likely and more prominent in areas where international standards are less important and where the UK has not inherited any EU regulations such as in the two areas already mentioned, green finance and crypto. While supervisory cooperation between EU and UK authorities might continue (and will be necessary in areas of regulatory equivalence), regulatory cooperation even if formalised will be less strong and there will not necessarily be any voluntary attempt by UK authorities to follow adjustments and changes in EU regulation and supervision. On the other hand, both the UK and the EU are members of global regulatory bodies across different segments of the financial system (FSB, Basel Committee) and this will effectively be a constraint on too much positive or negative divergence. High divergence: Under this final scenario, there would be a rather aggressive legislative and regulatory drive in the UK to diverge from EU rules. This would involve both replacing existing EU rules with new regulation and adopting divergent rules where such rules were not inherited, such as in green finance and crypto/digital finance more broadly. It can also include not following changes in EU legislation to thus mark differences between the two regulatory jurisdictions. We would expect such aggressive divergence especially in areas where UK authorities see growth opportunities and they feel less constrained by international fora and cooperation initiatives. Crypto is certainly an area where one could envision such aggressive divergence. Such high divergence, however, seems more likely under Recent trends in UK financial sector regulation and possible implications for the EU 47 PE 740.067 an institutional architecture in the UK where the independence of regulatory authorities has been significantly weakened (though not necessarily in a formal, i.e., legislative manner) and growth/competitiveness objectives are clearly prioritised over stability concerns. As we will discuss in section 3.2.2, which of the three scenarios will develop depends very much on how the overall political relationship between the EU and the UK will develop over the next years, with the Northern Ireland Protocol being the major hurdle in this relationship. 3.2.2. Disentangling the Northern Ireland Protocol situation to unblock/reactivate UKEU regulatory cooperation Resolving the dispute between the UK and the EU on the implementation of the Northern Ireland Protocol (NIP) seems key to rebuild trust and unblock UK-EU regulatory cooperation across a number of policy areas including the financial sector. Resolving this dispute requires political leadership from the UK Prime Minister taking office in October 2022, Rishi Sunak, and bringing on board both the European Research Group (ERG) of hardcore Brexiters in the British Parliament and Northern Ireland’s Unionists, not an easy feat. While immediate conflicts can be avoided by delaying the legislative process of the NIP Bill (which would override and breach the NIP and the Withdrawal Agreement), cooperation between UK and EU authorities on trade data provision from the UK to the EU, and not taking unilateral steps, the resolution of the ‘stand-off’ cannot be delayed forever. Namely, the Northern Ireland Executive has not been established since the 2022 May elections and new elections to the Legislative Assembly will have to be called in spring 2023, which raise the political temperature in the region. The upcoming 25th anniversary of the Good Friday Agreement in 2023 increases both internal and external (especially from the US) pressures. Finally, in case of increasing divergence in goods standards between the UK and the EU, there will be increasing pressure from the EU on properly monitoring trade between Great Britain and Northern Ireland. In case the conflict around the Northern Ireland Protocol can be resolved to the satisfaction of both sides, there should be few if any barriers for future cooperation between UK and EU authorities on financial sector issues. Addressing the stand-off around the NIP is thus a necessary though not sufficient condition. At the end of November 2022, the Council Presidency and the European Parliament actually reached a provisional agreement on a Regulation on ‘autonomous measures’ potentially taken as a retaliation and that would allow the EU to ensure ‘timely and effective exercise of its rights in enforcing and implementing’ the Withdrawal Agreement and the TCA162. At the same time, not long after, the European Commission Vice President Maroš Šefčovič stressed the ‘window of opportunity for a positive outcome’163 in the context of the extension of practical arrangements for veterinary medicines until December 2025. This positive ‘mood music’ has been echoed by Leo Varadkar, the Taoiseach in Ireland, who stressed the increased trust and flexibility between the UK and the EU – notwithstanding remaining differences164. There will certainly be competing interests (similar to what we could observe during the UK’s EU membership) and no expectations of complete convergence, but an institutional framework for regulatory dialogue could be put in place. 162 Council of the EU, ‘EU-UK Relations: Council Presidency and European Parliament Reach Provisional Agreement on a Regulation on Autonomous Measures’ (30 November 2022) https://www.consilium.europa.eu/en/press/press-releases/2022/11/30/eu-uk-relationscouncil-presidency-and-european-parliament-reach-provisional-agreement-on-a-regulation-on-autonomous-measures/, accessed 5 January 2023. 163 ‘Statement by Vice-President Maroš Šefčovič’ (European Commission, 19 December 2022) https://ec.europa.eu/commission/presscorner/detail/en/statement_22_7831, accessed 5 January 2023. 164 “Much Better Mood Music” in EU-UK Relations than at Any Period since Brexit Referendum - Taoiseach’ (n 22). IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 48 Before the resolution of this conflict, it is difficult to see any progress happening in terms of regulatory cooperation. Similar, if the conflict around the NIP escalates again, it is hard to envision any progress towards trade partnership of the UK with third countries such as the US.
USER:
What is the probable date range for this document
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 19 | 9 | 1,378 | null | 163 |
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
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explain, in plain language, why looser access to methadone medications is more important than ever because of the current fetnanyl epidemic in the united states
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Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl. Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence. Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid. It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5. Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP. SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention. Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centers found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths. Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict. The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions. Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines. Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients. Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioral treatment. Data suggest that counseling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counseling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation. Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> explain, in plain language, why looser access to methadone medications is more important than ever because of the current fetnanyl epidemic in the united states <TEXT> Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl. Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence. Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid. It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5. Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP. SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention. Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centers found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths. Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict. The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions. Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines. Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients. Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioral treatment. Data suggest that counseling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counseling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation. Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes. https://nida.nih.gov/about-nida/noras-blog/2024/07/to-address-the-fentanyl-crisis-greater-access-to-methadone-is-needed
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl. Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence. Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid. It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5. Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP. SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention. Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centers found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths. Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict. The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions. Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines. Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients. Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioral treatment. Data suggest that counseling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counseling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation. Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes.
USER:
explain, in plain language, why looser access to methadone medications is more important than ever because of the current fetnanyl epidemic in the united states
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 20 | 25 | 1,217 | null | 592 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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I am an investor in Coca-Cola but I am curious about some of the companies challenges right now. Give me a bullet list of raw product materials the company uses in making products are at risk of price volatility. Then explain what causes of that volatility could be. I'm not concerned about the concerns about sweeteners so I don't need to know about that. But tell me can social media have a negative impact on the company?
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Raw material costs, including the costs for plastic bottles, aluminum cans, PET resin, carbon dioxide and high fructose corn syrup, are subject to significant price volatility, which may be worsened by periods of increased demand, supply constraints or high inflation. International or domestic geopolitical or other events, including pandemics, armed conflict or the imposition of tariffs and/or quotas by the U.S. government on any of these raw materials, could adversely impact the supply and cost of these raw materials to the Company or render them unavailable at commercially favorable terms or at all. In addition, there are no limits on the prices The Coca-Cola Company and other beverage companies can charge for concentrate. If the Company cannot offset higher raw material costs with higher selling prices, effective commodity price hedging, increased sales volume or reductions in other costs, the Company’s results of operations and profitability could be adversely affected. The Company uses significant amounts of fuel for its delivery fleet and other vehicles used in the distribution of its products. International or domestic geopolitical or other events could impact the supply and cost of fuel and the timely delivery of the Company’s products to its customers. Although the Company strives to reduce fuel consumption and uses commodity hedges to manage the Company’s fuel costs, there can be no assurance the Company will succeed in limiting the impact of fuel price increases or price volatility on the Company’s business or future cost increases, which could reduce the profitability of the Company’s operations. The Company uses a combination of internal and external freight shipping and transportation services to transport and deliver products. The Company’s freight cost and the timely delivery of its products may be adversely impacted by a number of factors that could reduce the profitability of the Company’s operations, including driver shortages, reduced availability of independent contractor drivers, higher fuel costs, weather conditions, traffic congestion, increased government regulation and other matters. The Company continues to make significant reinvestments in its business in order to evolve its operating model and to accommodate future growth and portfolio expansion, including supply chain optimization. The increased costs associated with these reinvestments, the potential for disruption in manufacturing and distribution and the risk the Company may not realize a satisfactory return on its investments could adversely affect the Company’s business, financial condition or results of operations. The reliance on purchased finished products from external sources could have an adverse impact on the Company’s profitability. The Company does not, and does not plan to, manufacture all of the products it distributes and, therefore, remains reliant on purchased finished products from external sources to meet customer demand. As a result, the Company is subject to incremental risk, including, but not limited to, product quality and availability, price variability and production capacity shortfalls for externally purchased finished products, which could have an impact on the Company’s profitability and customer relationships. Particularly, the Company is subject to the risk of unavailability of still products that it acquires from other manufacturers, leading to an inability to meet consumer demand for these products. In most instances, the Company’s ability to negotiate the prices at which it purchases finished products from other U.S. Coca-Cola bottlers is limited pursuant to The Coca-Cola Company’s right to unilaterally establish the prices, or certain elements of the formulas used to determine the prices, for such finished products under the RMA, which could have an adverse impact on the Company’s profitability. Changes in public and consumer perception and preferences, including concerns related to product safety and sustainability, artificial ingredients, brand reputation and obesity, could reduce demand for the Company’s products and reduce profitability. Concerns about perceived negative safety and quality consequences of certain ingredients in the Company’s products, such as nonnutritive sweeteners or ingredients in energy drinks, may erode consumers’ confidence in the safety and quality of the Company’s products, whether or not justified. The Company’s business is also impacted by changes in consumer concerns or perceptions surrounding the product manufacturing processes and packaging materials, including single-use and other plastic packaging, and the environmental and sustainability impact of such manufacturing processes and packaging materials. Any of these factors may reduce consumers’ willingness to purchase the Company’s products and any inability on the part of the Company to anticipate or react to such changes could result in reduced demand for the Company’s products or erode the Company’s competitive and financial position and could adversely affect the Company’s business, reputation, financial condition or results of operations. The Company’s success depends on its ability to maintain consumer confidence in the safety and quality of all of its products. The Company has rigorous product safety and quality standards. However, if beverage products taken to market are or become contaminated or adulterated, the Company may be required to conduct costly product recalls and may become subject to product liability claims and negative publicity, which could cause its business and reputation to suffer. 9 The Company’s success also depends in large part on its ability and the ability of The Coca-Cola Company and other beverage companies it works with to maintain the brand image of existing products, build up brand image for new products and brand extensions and maintain its corporate reputation and social license to operate. Engagements by the Company’s executives in social and public policy debates may occasionally be the subject of criticism from advocacy groups that have differing points of view and could result in adverse media and consumer reaction, including product boycotts. Similarly, the Company’s sponsorship relationships and charitable giving program could subject the Company to negative publicity as a result of actual or perceived views of organizations the Company sponsors or supports financially. Likewise, negative postings or comments on social media or networking websites about the Company, The Coca-Cola Company or one of the products the Company carries, even if inaccurate or malicious, could generate adverse publicity that could damage the reputation of the Company’s brands or the Company. The Company’s business depends substantially on consumer tastes, preferences and shopping habits that change in often unpredictable ways. As a result of certain health and wellness trends, including concern over the public health consequences associated with obesity, consumer preferences over the past several years have shifted from sugar-sweetened sparkling beverages to diet sparkling beverages, tea, sports drinks, enhanced water and bottled water. As the Company distributes, markets and manufactures beverage brands owned by others, the success of the Company’s business depends in large measure on the ability of The Coca-Cola Company and other beverage companies to develop and introduce product innovations to meet the changing preferences of the broad consumer market, and failure to satisfy these consumer preferences could adversely affect the Company’s profitability
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"================ <TEXT PASSAGE> ======= Raw material costs, including the costs for plastic bottles, aluminum cans, PET resin, carbon dioxide and high fructose corn syrup, are subject to significant price volatility, which may be worsened by periods of increased demand, supply constraints or high inflation. International or domestic geopolitical or other events, including pandemics, armed conflict or the imposition of tariffs and/or quotas by the U.S. government on any of these raw materials, could adversely impact the supply and cost of these raw materials to the Company or render them unavailable at commercially favorable terms or at all. In addition, there are no limits on the prices The Coca-Cola Company and other beverage companies can charge for concentrate. If the Company cannot offset higher raw material costs with higher selling prices, effective commodity price hedging, increased sales volume or reductions in other costs, the Company’s results of operations and profitability could be adversely affected. The Company uses significant amounts of fuel for its delivery fleet and other vehicles used in the distribution of its products. International or domestic geopolitical or other events could impact the supply and cost of fuel and the timely delivery of the Company’s products to its customers. Although the Company strives to reduce fuel consumption and uses commodity hedges to manage the Company’s fuel costs, there can be no assurance the Company will succeed in limiting the impact of fuel price increases or price volatility on the Company’s business or future cost increases, which could reduce the profitability of the Company’s operations. The Company uses a combination of internal and external freight shipping and transportation services to transport and deliver products. The Company’s freight cost and the timely delivery of its products may be adversely impacted by a number of factors that could reduce the profitability of the Company’s operations, including driver shortages, reduced availability of independent contractor drivers, higher fuel costs, weather conditions, traffic congestion, increased government regulation and other matters. The Company continues to make significant reinvestments in its business in order to evolve its operating model and to accommodate future growth and portfolio expansion, including supply chain optimization. The increased costs associated with these reinvestments, the potential for disruption in manufacturing and distribution and the risk the Company may not realize a satisfactory return on its investments could adversely affect the Company’s business, financial condition or results of operations. The reliance on purchased finished products from external sources could have an adverse impact on the Company’s profitability. The Company does not, and does not plan to, manufacture all of the products it distributes and, therefore, remains reliant on purchased finished products from external sources to meet customer demand. As a result, the Company is subject to incremental risk, including, but not limited to, product quality and availability, price variability and production capacity shortfalls for externally purchased finished products, which could have an impact on the Company’s profitability and customer relationships. Particularly, the Company is subject to the risk of unavailability of still products that it acquires from other manufacturers, leading to an inability to meet consumer demand for these products. In most instances, the Company’s ability to negotiate the prices at which it purchases finished products from other U.S. Coca-Cola bottlers is limited pursuant to The Coca-Cola Company’s right to unilaterally establish the prices, or certain elements of the formulas used to determine the prices, for such finished products under the RMA, which could have an adverse impact on the Company’s profitability. Changes in public and consumer perception and preferences, including concerns related to product safety and sustainability, artificial ingredients, brand reputation and obesity, could reduce demand for the Company’s products and reduce profitability. Concerns about perceived negative safety and quality consequences of certain ingredients in the Company’s products, such as nonnutritive sweeteners or ingredients in energy drinks, may erode consumers’ confidence in the safety and quality of the Company’s products, whether or not justified. The Company’s business is also impacted by changes in consumer concerns or perceptions surrounding the product manufacturing processes and packaging materials, including single-use and other plastic packaging, and the environmental and sustainability impact of such manufacturing processes and packaging materials. Any of these factors may reduce consumers’ willingness to purchase the Company’s products and any inability on the part of the Company to anticipate or react to such changes could result in reduced demand for the Company’s products or erode the Company’s competitive and financial position and could adversely affect the Company’s business, reputation, financial condition or results of operations. The Company’s success depends on its ability to maintain consumer confidence in the safety and quality of all of its products. The Company has rigorous product safety and quality standards. However, if beverage products taken to market are or become contaminated or adulterated, the Company may be required to conduct costly product recalls and may become subject to product liability claims and negative publicity, which could cause its business and reputation to suffer. 9 The Company’s success also depends in large part on its ability and the ability of The Coca-Cola Company and other beverage companies it works with to maintain the brand image of existing products, build up brand image for new products and brand extensions and maintain its corporate reputation and social license to operate. Engagements by the Company’s executives in social and public policy debates may occasionally be the subject of criticism from advocacy groups that have differing points of view and could result in adverse media and consumer reaction, including product boycotts. Similarly, the Company’s sponsorship relationships and charitable giving program could subject the Company to negative publicity as a result of actual or perceived views of organizations the Company sponsors or supports financially. Likewise, negative postings or comments on social media or networking websites about the Company, The Coca-Cola Company or one of the products the Company carries, even if inaccurate or malicious, could generate adverse publicity that could damage the reputation of the Company’s brands or the Company. The Company’s business depends substantially on consumer tastes, preferences and shopping habits that change in often unpredictable ways. As a result of certain health and wellness trends, including concern over the public health consequences associated with obesity, consumer preferences over the past several years have shifted from sugar-sweetened sparkling beverages to diet sparkling beverages, tea, sports drinks, enhanced water and bottled water. As the Company distributes, markets and manufactures beverage brands owned by others, the success of the Company’s business depends in large measure on the ability of The Coca-Cola Company and other beverage companies to develop and introduce product innovations to meet the changing preferences of the broad consumer market, and failure to satisfy these consumer preferences could adversely affect the Company’s profitability https://investor.cokeconsolidated.com/static-files/198305e2-2559-4acc-954c-4123760b0f61 ================ <QUESTION> ======= I am an investor in Coca-Cola but I am curious about some of the companies challenges right now. Give me a bullet list of raw product materials the company uses in making products are at risk of price volatility. Then explain what causes of that volatility could be. I'm not concerned about the concerns about sweeteners so I don't need to know about that. But tell me can social media have a negative impact on the company? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
Raw material costs, including the costs for plastic bottles, aluminum cans, PET resin, carbon dioxide and high fructose corn syrup, are subject to significant price volatility, which may be worsened by periods of increased demand, supply constraints or high inflation. International or domestic geopolitical or other events, including pandemics, armed conflict or the imposition of tariffs and/or quotas by the U.S. government on any of these raw materials, could adversely impact the supply and cost of these raw materials to the Company or render them unavailable at commercially favorable terms or at all. In addition, there are no limits on the prices The Coca-Cola Company and other beverage companies can charge for concentrate. If the Company cannot offset higher raw material costs with higher selling prices, effective commodity price hedging, increased sales volume or reductions in other costs, the Company’s results of operations and profitability could be adversely affected. The Company uses significant amounts of fuel for its delivery fleet and other vehicles used in the distribution of its products. International or domestic geopolitical or other events could impact the supply and cost of fuel and the timely delivery of the Company’s products to its customers. Although the Company strives to reduce fuel consumption and uses commodity hedges to manage the Company’s fuel costs, there can be no assurance the Company will succeed in limiting the impact of fuel price increases or price volatility on the Company’s business or future cost increases, which could reduce the profitability of the Company’s operations. The Company uses a combination of internal and external freight shipping and transportation services to transport and deliver products. The Company’s freight cost and the timely delivery of its products may be adversely impacted by a number of factors that could reduce the profitability of the Company’s operations, including driver shortages, reduced availability of independent contractor drivers, higher fuel costs, weather conditions, traffic congestion, increased government regulation and other matters. The Company continues to make significant reinvestments in its business in order to evolve its operating model and to accommodate future growth and portfolio expansion, including supply chain optimization. The increased costs associated with these reinvestments, the potential for disruption in manufacturing and distribution and the risk the Company may not realize a satisfactory return on its investments could adversely affect the Company’s business, financial condition or results of operations. The reliance on purchased finished products from external sources could have an adverse impact on the Company’s profitability. The Company does not, and does not plan to, manufacture all of the products it distributes and, therefore, remains reliant on purchased finished products from external sources to meet customer demand. As a result, the Company is subject to incremental risk, including, but not limited to, product quality and availability, price variability and production capacity shortfalls for externally purchased finished products, which could have an impact on the Company’s profitability and customer relationships. Particularly, the Company is subject to the risk of unavailability of still products that it acquires from other manufacturers, leading to an inability to meet consumer demand for these products. In most instances, the Company’s ability to negotiate the prices at which it purchases finished products from other U.S. Coca-Cola bottlers is limited pursuant to The Coca-Cola Company’s right to unilaterally establish the prices, or certain elements of the formulas used to determine the prices, for such finished products under the RMA, which could have an adverse impact on the Company’s profitability. Changes in public and consumer perception and preferences, including concerns related to product safety and sustainability, artificial ingredients, brand reputation and obesity, could reduce demand for the Company’s products and reduce profitability. Concerns about perceived negative safety and quality consequences of certain ingredients in the Company’s products, such as nonnutritive sweeteners or ingredients in energy drinks, may erode consumers’ confidence in the safety and quality of the Company’s products, whether or not justified. The Company’s business is also impacted by changes in consumer concerns or perceptions surrounding the product manufacturing processes and packaging materials, including single-use and other plastic packaging, and the environmental and sustainability impact of such manufacturing processes and packaging materials. Any of these factors may reduce consumers’ willingness to purchase the Company’s products and any inability on the part of the Company to anticipate or react to such changes could result in reduced demand for the Company’s products or erode the Company’s competitive and financial position and could adversely affect the Company’s business, reputation, financial condition or results of operations. The Company’s success depends on its ability to maintain consumer confidence in the safety and quality of all of its products. The Company has rigorous product safety and quality standards. However, if beverage products taken to market are or become contaminated or adulterated, the Company may be required to conduct costly product recalls and may become subject to product liability claims and negative publicity, which could cause its business and reputation to suffer. 9 The Company’s success also depends in large part on its ability and the ability of The Coca-Cola Company and other beverage companies it works with to maintain the brand image of existing products, build up brand image for new products and brand extensions and maintain its corporate reputation and social license to operate. Engagements by the Company’s executives in social and public policy debates may occasionally be the subject of criticism from advocacy groups that have differing points of view and could result in adverse media and consumer reaction, including product boycotts. Similarly, the Company’s sponsorship relationships and charitable giving program could subject the Company to negative publicity as a result of actual or perceived views of organizations the Company sponsors or supports financially. Likewise, negative postings or comments on social media or networking websites about the Company, The Coca-Cola Company or one of the products the Company carries, even if inaccurate or malicious, could generate adverse publicity that could damage the reputation of the Company’s brands or the Company. The Company’s business depends substantially on consumer tastes, preferences and shopping habits that change in often unpredictable ways. As a result of certain health and wellness trends, including concern over the public health consequences associated with obesity, consumer preferences over the past several years have shifted from sugar-sweetened sparkling beverages to diet sparkling beverages, tea, sports drinks, enhanced water and bottled water. As the Company distributes, markets and manufactures beverage brands owned by others, the success of the Company’s business depends in large measure on the ability of The Coca-Cola Company and other beverage companies to develop and introduce product innovations to meet the changing preferences of the broad consumer market, and failure to satisfy these consumer preferences could adversely affect the Company’s profitability
USER:
I am an investor in Coca-Cola but I am curious about some of the companies challenges right now. Give me a bullet list of raw product materials the company uses in making products are at risk of price volatility. Then explain what causes of that volatility could be. I'm not concerned about the concerns about sweeteners so I don't need to know about that. But tell me can social media have a negative impact on the company?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 77 | 1,115 | null | 745 |
Your response should be based only on the text provided below. Do not use any outside resources or prior knowledge in formulating your answer.
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Tell me in a bullet-pointed list what differential diagnoses of Hypertensive Retinopathy are not shared with HIV Retinopathy or with Diabetic Retinopathy.
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Diabetic Retinopathy ■ Essentials of Diagnosis • May have decreased or fluctuating vision or floaters; often asymptomatic early in the course of the disease • Nonproliferative: Dot and blot hemorrhages, microaneurysms, hard exudates, cotton-wool spots, venous beading, and intraretinal microvascular abnormalities • Proliferative: Neovascularization of optic disk, retina, or iris; preretinal or vitreous hemorrhages; tractional retinal detachment ■ Differential Diagnosis • Hypertensive retinopathy • HIV retinopathy • Radiation retinopathy • Central or branch retinal vein occlusion • Ocular ischemic syndrome • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Collagen vascular disease • Sarcoidosis • Eales’ disease ■ Treatment • Ophthalmologic referral and regular follow-up in all diabetics • Laser photocoagulation, intravitreal Kenalog, intravitreal antiangiogenesis drugs (eg, Lucentis or Avastin) for macular edema and proliferative disease • Pars plana vitrectomy for nonclearing vitreous hemorrhage and tractional retinal detachment involving or threatening the macula ■ Pearl Though a debate about this has lasted decades, it appears that aggressive glycemic control prevents progression; be sure your patients understand and know their A1c. Reference El-Asrar AM, Al-Mezaine HS, Ola MS. Changing paradigms in the treatment of diabetic retinopathy. Curr Opin Ophthalmol 2009;20:532. [PMID: 19644368] 20 518 Current Essentials of Medicine HIV Retinopathy ■ Essentials of Diagnosis • Cotton-wool spots, intraretinal hemorrhages, microaneurysms seen on funduscopic examination in a patient with known or suspected HIV infection • Typically asymptomatic unless accompanied by other HIV-related retinal pathology (eg, cytomegalovirus retinitis) ■ Differential Diagnosis • Diabetic retinopathy • Hypertensive retinopathy • Radiation retinopathy • Retinopathy of severe anemia • Central or branch retinal vein occlusion • Sickle cell retinopathy • Embolization from intravenous drug abuse (talc retinopathy) • Sarcoidosis • Eales’ disease ■ Treatment • Treat the underlying HIV disease • Ophthalmologic referral is appropriate for any patient with HIV, especially with a low CD4 count and/or visual symptoms ■ Pearl HIV retinopathy is the most common ophthalmologic manifestation of HIV infection; it usually indicates a low CD4 count. Reference Holland GN. AIDS and ophthalmology: the first quarter century. Am J Ophthalmol 2008;145:397. [PMID: 18282490] Hypertensive Retinopathy ■ Essentials of Diagnosis • Usually asymptomatic; may have decreased vision • Generalized or localized retinal arteriolar narrowing, almost always bilateral • Arteriovenous crossing changes (AV nicking), retinal arteriolar sclerosis (copper or silver wiring), cotton-wool spots, hard exudates, flame-shaped hemorrhages, retinal edema, arterial macroaneurysms, chorioretinal atrophy • Optic disk edema in malignant hypertension ■ Differential Diagnosis • Diabetic retinopathy • Radiation retinopathy • HIV retinopathy • Central or branch retinal vein occlusion • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Autoimmune disease • Sarcoidosis • Eales’ disease ■ Treatment • Treat the hypertension • Ophthalmologic referral ■ Pearl The only pathognomonic funduscopic change of hypertension is focal arteriolar narrowing due to spasm, and it is typically seen in hypertensive crisis. Reference DellaCroce JT, Vitale AT. Hypertension and the eye. Curr Opin Ophthalmol 2008;19:493. [PMID: 18854694]
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Your response should be based only on the text provided below. Do not use any outside resources or prior knowledge in formulating your answer. Diabetic Retinopathy ■ Essentials of Diagnosis • May have decreased or fluctuating vision or floaters; often asymptomatic early in the course of the disease • Nonproliferative: Dot and blot hemorrhages, microaneurysms, hard exudates, cotton-wool spots, venous beading, and intraretinal microvascular abnormalities • Proliferative: Neovascularization of optic disk, retina, or iris; preretinal or vitreous hemorrhages; tractional retinal detachment ■ Differential Diagnosis • Hypertensive retinopathy • HIV retinopathy • Radiation retinopathy • Central or branch retinal vein occlusion • Ocular ischemic syndrome • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Collagen vascular disease • Sarcoidosis • Eales’ disease ■ Treatment • Ophthalmologic referral and regular follow-up in all diabetics • Laser photocoagulation, intravitreal Kenalog, intravitreal antiangiogenesis drugs (eg, Lucentis or Avastin) for macular edema and proliferative disease • Pars plana vitrectomy for nonclearing vitreous hemorrhage and tractional retinal detachment involving or threatening the macula ■ Pearl Though a debate about this has lasted decades, it appears that aggressive glycemic control prevents progression; be sure your patients understand and know their A1c. Reference El-Asrar AM, Al-Mezaine HS, Ola MS. Changing paradigms in the treatment of diabetic retinopathy. Curr Opin Ophthalmol 2009;20:532. [PMID: 19644368] 20 518 Current Essentials of Medicine HIV Retinopathy ■ Essentials of Diagnosis • Cotton-wool spots, intraretinal hemorrhages, microaneurysms seen on funduscopic examination in a patient with known or suspected HIV infection • Typically asymptomatic unless accompanied by other HIV-related retinal pathology (eg, cytomegalovirus retinitis) ■ Differential Diagnosis • Diabetic retinopathy • Hypertensive retinopathy • Radiation retinopathy • Retinopathy of severe anemia • Central or branch retinal vein occlusion • Sickle cell retinopathy • Embolization from intravenous drug abuse (talc retinopathy) • Sarcoidosis • Eales’ disease ■ Treatment • Treat the underlying HIV disease • Ophthalmologic referral is appropriate for any patient with HIV, especially with a low CD4 count and/or visual symptoms ■ Pearl HIV retinopathy is the most common ophthalmologic manifestation of HIV infection; it usually indicates a low CD4 count. Reference Holland GN. AIDS and ophthalmology: the first quarter century. Am J Ophthalmol 2008;145:397. [PMID: 18282490] Hypertensive Retinopathy ■ Essentials of Diagnosis • Usually asymptomatic; may have decreased vision • Generalized or localized retinal arteriolar narrowing, almost always bilateral • Arteriovenous crossing changes (AV nicking), retinal arteriolar sclerosis (copper or silver wiring), cotton-wool spots, hard exudates, flame-shaped hemorrhages, retinal edema, arterial macroaneurysms, chorioretinal atrophy • Optic disk edema in malignant hypertension ■ Differential Diagnosis • Diabetic retinopathy • Radiation retinopathy • HIV retinopathy • Central or branch retinal vein occlusion • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Autoimmune disease • Sarcoidosis • Eales’ disease ■ Treatment • Treat the hypertension • Ophthalmologic referral ■ Pearl The only pathognomonic funduscopic change of hypertension is focal arteriolar narrowing due to spasm, and it is typically seen in hypertensive crisis. Reference DellaCroce JT, Vitale AT. Hypertension and the eye. Curr Opin Ophthalmol 2008;19:493. [PMID: 18854694] Tell me in a bullet-pointed list what differential diagnoses of Hypertensive Retinopathy are not shared with HIV Retinopathy or with Diabetic Retinopathy.
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Your response should be based only on the text provided below. Do not use any outside resources or prior knowledge in formulating your answer.
EVIDENCE:
Diabetic Retinopathy ■ Essentials of Diagnosis • May have decreased or fluctuating vision or floaters; often asymptomatic early in the course of the disease • Nonproliferative: Dot and blot hemorrhages, microaneurysms, hard exudates, cotton-wool spots, venous beading, and intraretinal microvascular abnormalities • Proliferative: Neovascularization of optic disk, retina, or iris; preretinal or vitreous hemorrhages; tractional retinal detachment ■ Differential Diagnosis • Hypertensive retinopathy • HIV retinopathy • Radiation retinopathy • Central or branch retinal vein occlusion • Ocular ischemic syndrome • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Collagen vascular disease • Sarcoidosis • Eales’ disease ■ Treatment • Ophthalmologic referral and regular follow-up in all diabetics • Laser photocoagulation, intravitreal Kenalog, intravitreal antiangiogenesis drugs (eg, Lucentis or Avastin) for macular edema and proliferative disease • Pars plana vitrectomy for nonclearing vitreous hemorrhage and tractional retinal detachment involving or threatening the macula ■ Pearl Though a debate about this has lasted decades, it appears that aggressive glycemic control prevents progression; be sure your patients understand and know their A1c. Reference El-Asrar AM, Al-Mezaine HS, Ola MS. Changing paradigms in the treatment of diabetic retinopathy. Curr Opin Ophthalmol 2009;20:532. [PMID: 19644368] 20 518 Current Essentials of Medicine HIV Retinopathy ■ Essentials of Diagnosis • Cotton-wool spots, intraretinal hemorrhages, microaneurysms seen on funduscopic examination in a patient with known or suspected HIV infection • Typically asymptomatic unless accompanied by other HIV-related retinal pathology (eg, cytomegalovirus retinitis) ■ Differential Diagnosis • Diabetic retinopathy • Hypertensive retinopathy • Radiation retinopathy • Retinopathy of severe anemia • Central or branch retinal vein occlusion • Sickle cell retinopathy • Embolization from intravenous drug abuse (talc retinopathy) • Sarcoidosis • Eales’ disease ■ Treatment • Treat the underlying HIV disease • Ophthalmologic referral is appropriate for any patient with HIV, especially with a low CD4 count and/or visual symptoms ■ Pearl HIV retinopathy is the most common ophthalmologic manifestation of HIV infection; it usually indicates a low CD4 count. Reference Holland GN. AIDS and ophthalmology: the first quarter century. Am J Ophthalmol 2008;145:397. [PMID: 18282490] Hypertensive Retinopathy ■ Essentials of Diagnosis • Usually asymptomatic; may have decreased vision • Generalized or localized retinal arteriolar narrowing, almost always bilateral • Arteriovenous crossing changes (AV nicking), retinal arteriolar sclerosis (copper or silver wiring), cotton-wool spots, hard exudates, flame-shaped hemorrhages, retinal edema, arterial macroaneurysms, chorioretinal atrophy • Optic disk edema in malignant hypertension ■ Differential Diagnosis • Diabetic retinopathy • Radiation retinopathy • HIV retinopathy • Central or branch retinal vein occlusion • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Autoimmune disease • Sarcoidosis • Eales’ disease ■ Treatment • Treat the hypertension • Ophthalmologic referral ■ Pearl The only pathognomonic funduscopic change of hypertension is focal arteriolar narrowing due to spasm, and it is typically seen in hypertensive crisis. Reference DellaCroce JT, Vitale AT. Hypertension and the eye. Curr Opin Ophthalmol 2008;19:493. [PMID: 18854694]
USER:
Tell me in a bullet-pointed list what differential diagnoses of Hypertensive Retinopathy are not shared with HIV Retinopathy or with Diabetic Retinopathy.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 22 | 495 | null | 584 |
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
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How does a 10-week diet rich in fermented foods regulate the immune system? What are the implications of regulating the immune system for inflammation? Please give examples.
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Fermented-food diet increases microbiome diversity, decreases inflammatory proteins, study finds Stanford researchers discover that a 10-week diet high in fermented foods boosts microbiome diversity and improves immune responses. July 12, 2021 - By Janelle Weaver A diet rich in fermented foods enhances the diversity of gut microbes and decreases molecular signs of inflammation, according to researchers at the Stanford School of Medicine. In a clinical trial, 36 healthy adults were randomly assigned to a 10-week diet that included either fermented or high-fiber foods. The two diets resulted in different effects on the gut microbiome and the immune system. Eating foods such as yogurt, kefir, fermented cottage cheese, kimchi and other fermented vegetables, vegetable brine drinks, and kombucha tea led to an increase in overall microbial diversity, with stronger effects from larger servings. “This is a stunning finding,” said Justin Sonnenburg, PhD, an associate professor of microbiology and immunology. “It provides one of the first examples of how a simple change in diet can reproducibly remodel the microbiota across a cohort of healthy adults.” In addition, four types of immune cells showed less activation in the fermented-food group. The levels of 19 inflammatory proteins measured in blood samples also decreased. One of these proteins, interleukin 6, has been linked to conditions such as rheumatoid arthritis, Type 2 diabetes and chronic stress. “Microbiota-targeted diets can change immune status, providing a promising avenue for decreasing inflammation in healthy adults,” said Christopher Gardner, PhD, the Rehnborg Farquhar Professor and director of nutrition studies at the Stanford Prevention Research Center. “This finding was consistent across all participants in the study who were assigned to the higher fermented food group.” Justin Sonnenburg Justin Sonnenburg Microbe diversity stable in fiber-rich diet By contrast, none of these 19 inflammatory proteins decreased in participants assigned to a high-fiber diet rich in legumes, seeds, whole grains, nuts, vegetables and fruits. On average, the diversity of their gut microbes also remained stable. “We expected high fiber to have a more universally beneficial effect and increase microbiota diversity,” said Erica Sonnenburg, PhD, a senior research scientist in basic life sciences, microbiology and immunology. “The data suggest that increased fiber intake alone over a short time period is insufficient to increase microbiota diversity.” The study published online July 12 in Cell. Justin and Erica Sonnenburg and Christopher Gardner are co-senior authors. The lead authors are Hannah Wastyk, a PhD student in bioengineering, and former postdoctoral scholar Gabriela Fragiadakis, PhD, who is now an assistant professor of medicine at UC-San Francisco. A wide body of evidence has demonstrated that diet shapes the gut microbiome, which can affect the immune system and overall health. According to Gardner, low microbiome diversity has been linked to obesity and diabetes. “We wanted to conduct a proof-of-concept study that could test whether microbiota-targeted food could be an avenue for combatting the overwhelming rise in chronic inflammatory diseases,” Gardner said. The researchers focused on fiber and fermented foods due to previous reports of their potential health benefits. While high-fiber diets have been associated with lower rates of mortality, the consumption of fermented foods can help with weight maintenance and may decrease the risk of diabetes, cancer and cardiovascular disease. Erica Sonnenburg Erica Sonnenburg The researchers analyzed blood and stool samples collected during a three-week pre-trial period, the 10 weeks of the diet, and a four-week period after the diet when the participants ate as they chose. The findings paint a nuanced picture of the influence of diet on gut microbes and immune status. On one hand, those who increased their consumption of fermented foods showed similar effects on their microbiome diversity and inflammatory markers, consistent with prior research showing that short-term changes in diet can rapidly alter the gut microbiome. On the other hand, the limited change in the microbiome within the high-fiber group dovetails with the researchers’ previous reports of a general resilience of the human microbiome over short time periods.
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. How does a 10-week diet rich in fermented foods regulate the immune system? What are the implications of regulating the immune system for inflammation? Please give examples. Fermented-food diet increases microbiome diversity, decreases inflammatory proteins, study finds Stanford researchers discover that a 10-week diet high in fermented foods boosts microbiome diversity and improves immune responses. July 12, 2021 - By Janelle Weaver A diet rich in fermented foods enhances the diversity of gut microbes and decreases molecular signs of inflammation, according to researchers at the Stanford School of Medicine. In a clinical trial, 36 healthy adults were randomly assigned to a 10-week diet that included either fermented or high-fiber foods. The two diets resulted in different effects on the gut microbiome and the immune system. Eating foods such as yogurt, kefir, fermented cottage cheese, kimchi and other fermented vegetables, vegetable brine drinks, and kombucha tea led to an increase in overall microbial diversity, with stronger effects from larger servings. “This is a stunning finding,” said Justin Sonnenburg, PhD, an associate professor of microbiology and immunology. “It provides one of the first examples of how a simple change in diet can reproducibly remodel the microbiota across a cohort of healthy adults.” In addition, four types of immune cells showed less activation in the fermented-food group. The levels of 19 inflammatory proteins measured in blood samples also decreased. One of these proteins, interleukin 6, has been linked to conditions such as rheumatoid arthritis, Type 2 diabetes and chronic stress. “Microbiota-targeted diets can change immune status, providing a promising avenue for decreasing inflammation in healthy adults,” said Christopher Gardner, PhD, the Rehnborg Farquhar Professor and director of nutrition studies at the Stanford Prevention Research Center. “This finding was consistent across all participants in the study who were assigned to the higher fermented food group.” Justin Sonnenburg Justin Sonnenburg Microbe diversity stable in fiber-rich diet By contrast, none of these 19 inflammatory proteins decreased in participants assigned to a high-fiber diet rich in legumes, seeds, whole grains, nuts, vegetables and fruits. On average, the diversity of their gut microbes also remained stable. “We expected high fiber to have a more universally beneficial effect and increase microbiota diversity,” said Erica Sonnenburg, PhD, a senior research scientist in basic life sciences, microbiology and immunology. “The data suggest that increased fiber intake alone over a short time period is insufficient to increase microbiota diversity.” The study published online July 12 in Cell. Justin and Erica Sonnenburg and Christopher Gardner are co-senior authors. The lead authors are Hannah Wastyk, a PhD student in bioengineering, and former postdoctoral scholar Gabriela Fragiadakis, PhD, who is now an assistant professor of medicine at UC-San Francisco. A wide body of evidence has demonstrated that diet shapes the gut microbiome, which can affect the immune system and overall health. According to Gardner, low microbiome diversity has been linked to obesity and diabetes. “We wanted to conduct a proof-of-concept study that could test whether microbiota-targeted food could be an avenue for combatting the overwhelming rise in chronic inflammatory diseases,” Gardner said. The researchers focused on fiber and fermented foods due to previous reports of their potential health benefits. While high-fiber diets have been associated with lower rates of mortality, the consumption of fermented foods can help with weight maintenance and may decrease the risk of diabetes, cancer and cardiovascular disease. Erica Sonnenburg Erica Sonnenburg The researchers analyzed blood and stool samples collected during a three-week pre-trial period, the 10 weeks of the diet, and a four-week period after the diet when the participants ate as they chose. The findings paint a nuanced picture of the influence of diet on gut microbes and immune status. On one hand, those who increased their consumption of fermented foods showed similar effects on their microbiome diversity and inflammatory markers, consistent with prior research showing that short-term changes in diet can rapidly alter the gut microbiome. On the other hand, the limited change in the microbiome within the high-fiber group dovetails with the researchers’ previous reports of a general resilience of the human microbiome over short time periods. https://med.stanford.edu/news/all-news/2021/07/fermented-food-diet-increases-microbiome-diversity-lowers-inflammation
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Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
EVIDENCE:
Fermented-food diet increases microbiome diversity, decreases inflammatory proteins, study finds Stanford researchers discover that a 10-week diet high in fermented foods boosts microbiome diversity and improves immune responses. July 12, 2021 - By Janelle Weaver A diet rich in fermented foods enhances the diversity of gut microbes and decreases molecular signs of inflammation, according to researchers at the Stanford School of Medicine. In a clinical trial, 36 healthy adults were randomly assigned to a 10-week diet that included either fermented or high-fiber foods. The two diets resulted in different effects on the gut microbiome and the immune system. Eating foods such as yogurt, kefir, fermented cottage cheese, kimchi and other fermented vegetables, vegetable brine drinks, and kombucha tea led to an increase in overall microbial diversity, with stronger effects from larger servings. “This is a stunning finding,” said Justin Sonnenburg, PhD, an associate professor of microbiology and immunology. “It provides one of the first examples of how a simple change in diet can reproducibly remodel the microbiota across a cohort of healthy adults.” In addition, four types of immune cells showed less activation in the fermented-food group. The levels of 19 inflammatory proteins measured in blood samples also decreased. One of these proteins, interleukin 6, has been linked to conditions such as rheumatoid arthritis, Type 2 diabetes and chronic stress. “Microbiota-targeted diets can change immune status, providing a promising avenue for decreasing inflammation in healthy adults,” said Christopher Gardner, PhD, the Rehnborg Farquhar Professor and director of nutrition studies at the Stanford Prevention Research Center. “This finding was consistent across all participants in the study who were assigned to the higher fermented food group.” Justin Sonnenburg Justin Sonnenburg Microbe diversity stable in fiber-rich diet By contrast, none of these 19 inflammatory proteins decreased in participants assigned to a high-fiber diet rich in legumes, seeds, whole grains, nuts, vegetables and fruits. On average, the diversity of their gut microbes also remained stable. “We expected high fiber to have a more universally beneficial effect and increase microbiota diversity,” said Erica Sonnenburg, PhD, a senior research scientist in basic life sciences, microbiology and immunology. “The data suggest that increased fiber intake alone over a short time period is insufficient to increase microbiota diversity.” The study published online July 12 in Cell. Justin and Erica Sonnenburg and Christopher Gardner are co-senior authors. The lead authors are Hannah Wastyk, a PhD student in bioengineering, and former postdoctoral scholar Gabriela Fragiadakis, PhD, who is now an assistant professor of medicine at UC-San Francisco. A wide body of evidence has demonstrated that diet shapes the gut microbiome, which can affect the immune system and overall health. According to Gardner, low microbiome diversity has been linked to obesity and diabetes. “We wanted to conduct a proof-of-concept study that could test whether microbiota-targeted food could be an avenue for combatting the overwhelming rise in chronic inflammatory diseases,” Gardner said. The researchers focused on fiber and fermented foods due to previous reports of their potential health benefits. While high-fiber diets have been associated with lower rates of mortality, the consumption of fermented foods can help with weight maintenance and may decrease the risk of diabetes, cancer and cardiovascular disease. Erica Sonnenburg Erica Sonnenburg The researchers analyzed blood and stool samples collected during a three-week pre-trial period, the 10 weeks of the diet, and a four-week period after the diet when the participants ate as they chose. The findings paint a nuanced picture of the influence of diet on gut microbes and immune status. On one hand, those who increased their consumption of fermented foods showed similar effects on their microbiome diversity and inflammatory markers, consistent with prior research showing that short-term changes in diet can rapidly alter the gut microbiome. On the other hand, the limited change in the microbiome within the high-fiber group dovetails with the researchers’ previous reports of a general resilience of the human microbiome over short time periods.
USER:
How does a 10-week diet rich in fermented foods regulate the immune system? What are the implications of regulating the immune system for inflammation? Please give examples.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 24 | 27 | 652 | null | 532 |
System Instruction: [You must respond using a maximum of 5 sentences. You must only use information contained within the context block to formulate your response. If you cannot provide an answer using just the context block, you must use the phrase "I cannot provide an answer to your question."]
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User Question: [According to the provided article, what method of temperature measurement is best for a 2-year-old child?]
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Context Block: [Methods of Measurement: Methods of measuring a client’s body temperature vary based on developmental age, cognitive functioning, level of consciousness, state of health, safety, and agency/unit policy. The healthcare provider chooses the best method after considering client safety, accuracy, and least invasiveness, all contingent on the client’s health and illness state. The most accurate way to measure core body temperature is an invasive method through a pulmonary artery catheter. This is only performed in a critical care area when constant measurements are required along with other life-saving interventions. Methods of measurement include oral, axillary, tympanic, rectal, and dermal routes. Oral temperature can be taken with clients who can follow instructions, so this kind of measurement is common for clients over the age of four, or even younger children if they are cooperative. Another route other than oral (e.g., tympanic or axillary) is preferable when a client is on oxygen delivered via a face mask because this can alter the temperature. For children younger than four, axillary temperature is commonly measured unless a more accurate reading is required. Rectal temperature is an accurate way to measure body temperature (Mazerolle, Ganio, Casa, Vingren, & Klau, 2011). The rectal route is recommended by the Canadian Pediatric Society for children under two years of age (Leduc & Woods, 2017). However, this method is not used on infants younger than thirty days or premature infants because of the risk of rectal tearing. If the rectal method is required, the procedure is generally only used by nurses and physicians. Dermal routes are alternative methods of measurement that may be used in some agencies and practice areas. This method can involve holding the device and sliding it over the skin of the forehead and then down over the temporal artery in one motion. Dermal strips can also be placed on the forehead to measure skin temperature, but are not yet widely used, and the accuracy of this method has not yet been verified. More recently, there has been an increase in non-contact infrared thermometers particularly in the era of COVID-19 and other highly transmissible diseases. Depending on the type, these thermometers can be held at a short distance from the forehead or temporal area to measure temperature. Alternatively, some handheld thermal scanners that use an infrared camera can be held at a greater distance to screen large masses of people. Please refer to the manufacturer’s suggested reference range for non-contact infrared thermometers and thermal scanners.]
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System Instruction: [You must respond using a maximum of 5 sentences. You must only use information contained within the context block to formulate your response. If you cannot provide an answer using just the context block, you must use the phrase "I cannot provide an answer to your question."] User Question: [According to the provided article, what method of temperature measurement is best for a 2-year-old child?] Context Block: [Methods of Measurement: Methods of measuring a client’s body temperature vary based on developmental age, cognitive functioning, level of consciousness, state of health, safety, and agency/unit policy. The healthcare provider chooses the best method after considering client safety, accuracy, and least invasiveness, all contingent on the client’s health and illness state. The most accurate way to measure core body temperature is an invasive method through a pulmonary artery catheter. This is only performed in a critical care area when constant measurements are required along with other life-saving interventions. Methods of measurement include oral, axillary, tympanic, rectal, and dermal routes. Oral temperature can be taken with clients who can follow instructions, so this kind of measurement is common for clients over the age of four, or even younger children if they are cooperative. Another route other than oral (e.g., tympanic or axillary) is preferable when a client is on oxygen delivered via a face mask because this can alter the temperature. For children younger than four, axillary temperature is commonly measured unless a more accurate reading is required. Rectal temperature is an accurate way to measure body temperature (Mazerolle, Ganio, Casa, Vingren, & Klau, 2011). The rectal route is recommended by the Canadian Pediatric Society for children under two years of age (Leduc & Woods, 2017). However, this method is not used on infants younger than thirty days or premature infants because of the risk of rectal tearing. If the rectal method is required, the procedure is generally only used by nurses and physicians. Dermal routes are alternative methods of measurement that may be used in some agencies and practice areas. This method can involve holding the device and sliding it over the skin of the forehead and then down over the temporal artery in one motion. Dermal strips can also be placed on the forehead to measure skin temperature, but are not yet widely used, and the accuracy of this method has not yet been verified. More recently, there has been an increase in non-contact infrared thermometers particularly in the era of COVID-19 and other highly transmissible diseases. Depending on the type, these thermometers can be held at a short distance from the forehead or temporal area to measure temperature. Alternatively, some handheld thermal scanners that use an infrared camera can be held at a greater distance to screen large masses of people. Please refer to the manufacturer’s suggested reference range for non-contact infrared thermometers and thermal scanners.]
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System Instruction: [You must respond using a maximum of 5 sentences. You must only use information contained within the context block to formulate your response. If you cannot provide an answer using just the context block, you must use the phrase "I cannot provide an answer to your question."]
EVIDENCE:
Context Block: [Methods of Measurement: Methods of measuring a client’s body temperature vary based on developmental age, cognitive functioning, level of consciousness, state of health, safety, and agency/unit policy. The healthcare provider chooses the best method after considering client safety, accuracy, and least invasiveness, all contingent on the client’s health and illness state. The most accurate way to measure core body temperature is an invasive method through a pulmonary artery catheter. This is only performed in a critical care area when constant measurements are required along with other life-saving interventions. Methods of measurement include oral, axillary, tympanic, rectal, and dermal routes. Oral temperature can be taken with clients who can follow instructions, so this kind of measurement is common for clients over the age of four, or even younger children if they are cooperative. Another route other than oral (e.g., tympanic or axillary) is preferable when a client is on oxygen delivered via a face mask because this can alter the temperature. For children younger than four, axillary temperature is commonly measured unless a more accurate reading is required. Rectal temperature is an accurate way to measure body temperature (Mazerolle, Ganio, Casa, Vingren, & Klau, 2011). The rectal route is recommended by the Canadian Pediatric Society for children under two years of age (Leduc & Woods, 2017). However, this method is not used on infants younger than thirty days or premature infants because of the risk of rectal tearing. If the rectal method is required, the procedure is generally only used by nurses and physicians. Dermal routes are alternative methods of measurement that may be used in some agencies and practice areas. This method can involve holding the device and sliding it over the skin of the forehead and then down over the temporal artery in one motion. Dermal strips can also be placed on the forehead to measure skin temperature, but are not yet widely used, and the accuracy of this method has not yet been verified. More recently, there has been an increase in non-contact infrared thermometers particularly in the era of COVID-19 and other highly transmissible diseases. Depending on the type, these thermometers can be held at a short distance from the forehead or temporal area to measure temperature. Alternatively, some handheld thermal scanners that use an infrared camera can be held at a greater distance to screen large masses of people. Please refer to the manufacturer’s suggested reference range for non-contact infrared thermometers and thermal scanners.]
USER:
User Question: [According to the provided article, what method of temperature measurement is best for a 2-year-old child?]
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 49 | 18 | 410 | null | 282 |
Using only the information provided in the context block, provide the answer in a bullet point list, bolding the reasoning keyword and following it with a description in unbolded text like this: * **Reasoning Keyword**: Explanation....
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How should I handle credit card debt?
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Your First Step—Making a Financial Plan What are the things you want to save and invest for? • a home • a car • an education • a comfortable retirement • your children • medical or other emergencies • periods of unemployment • caring for parents Make your own list and then think about which goals are the most important to you. List your most important goals first. Decide how many years you have to meet each specific goal, because when you save or invest you’ll need to find a savings or investment option that fits your time frame for meeting each goal. Many tools exist to help you put your financial plan together. You’ll find a wealth of information, including calculators and links to non-commercial resources at Investor.gov. KNOW YOUR CURRENT FINANCIAL SITUATION Sit down and take an honest look at your entire financial situation. You can never take a journey without knowing where you’re starting from, and a journey to financial security is no different. You’ll need to figure out on paper your current situation—what you own and what you owe. You’ll be creating a “net worth statement.” On one side of the page, list what you own. These are your “assets.” And on the other side list what you owe other people, your “liabilities” or debts. Subtract your liabilities from your assets. If your assets are larger than your liabilities, you have a “positive” net worth. If your liabilities are greater than your assets, you have a “negative” net worth. You’ll want to update your “net worth statement” every year to keep track of how you are doing. Don’t be discouraged if you have a negative net worth. If you follow a plan to get into a positive position, you’re doing the right thing. KNOW YOUR INCOME AND EXPENSES The next step is to keep track of your income and your expenses for every month. Write down what you and others in your family earn, and then your monthly expenses. PAY YOURSELF OR YOUR FAMILY FIRST Include a category for savings and investing. What are you paying yourself every month? Many people get into the habit of saving and investing by following this advice: always pay yourself or your family first. Many people find it easier to pay themselves first if they allow their bank to automatically remove money from their paycheck and deposit it into a savings or investment account. Likely even better, for tax purposes, is to participate in an employer-sponsored retirement plan such as a 401(k), 403(b), or 457(b). These plans will typically not only automatically deduct money from your paycheck, but will immediately reduce the taxes you are paying. Additionally, in many plans the employer matches some or all of your contribution. When your employer does that, it’s offering “free money.” Any time you have automatic deductions made from your paycheck or bank account, you’ll increase the chances of being able to stick to your plan and to realize your goals. FINDING MONEY TO SAVE OR INVEST If you are spending all your income, and never have money to save or invest, you’ll need to look for ways to cut back on your expenses. When you watch where you spend your money, you will be surprised how small everyday expenses that you can do without add up over a year. Small Savings Add Up to Big Money How much does a cup of coffee cost you? If you buy a cup of coffee every day for $1.00 (an awfully good price for a decent cup of coffee, nowadays), that adds up to $365.00 a year. If you saved that $365.00 for just one year, and put it into a savings account or investment that earns 5% a year, it would grow to $465.84 by the end of 5 years, and by the end of 30 years, to $1,577.50. That’s the power of “compounding.” With compound interest, you earn interest on the money you save and on the interest that money earns. Over time, even a small amount saved can add up to big money. If you are willing to watch what you spend and look for little ways to save on a regular schedule, you can make money grow. You just did it with one cup of coffee. If a small cup of coffee can make such a huge difference, start looking at how you could make your money grow if you decided to spend less on other things and save those extra dollars. If you buy on impulse, make a rule that you’ll always wait 24 hours to buy anything. You may lose your desire to buy it after a day. And try emptying your pockets and wallet of spare change at the end of each day. You’ll be surprised how quickly those nickels and dimes add up! PAY OFF CREDIT CARD OR OTHER HIGH INTEREST DEBT Speaking of things adding up, few investment strategies pay off as well as, or with less risk than, merely paying off all high interest debt you may have. Many people have wallets filled with credit cards, some of which they’ve “maxed out” (meaning they’ve spent up to their credit limit). Credit cards can make it seem easy to buy expensive things when you don’t have the cash in your pocket—or in the bank. But credit cards aren’t free money. Most credit cards charge high interest rates—as much as 18 percent or more—if you don’t pay off your balance in full each month. If you owe money on your credit cards, the wisest thing you can do is pay off the balance in full as quickly as possible. Virtually no investment will give you the high returns you’ll need to keep pace with an 18 percent interest charge. That’s why you’re better off eliminating all credit card debt before investing savings. Once you’ve paid off your credit cards, you can budget your money and begin to save and invest. Here are some tips for avoiding credit card debt: Put Away the Plastic Don’t use a credit card unless your debt is at a manageable level and you know you’ll have the money to pay the bill when it arrives. Know What You Owe It’s easy to forget how much you’ve charged on your credit card. Every time you use a credit card, write down how much you have spent and figure out how much you’ll have to pay that month. If you know you won’t be able to pay your balance in full, try to figure out how much you can pay each month and how long it’ll take to pay the balance in full. Pay Off the Card with the Highest Rate If you’ve got unpaid balances on several credit cards, you should first pay down the card that charges the highest rate. Pay as much as you can toward that debt each month until your balance is once again zero, while still paying the minimum on your other cards. The same advice goes for any other high interest debt (about 8% or above) which does not offer the tax advantages of, for example, a mortgage. Now, once you have paid off those credit cards and begun to set aside some money to save and invest, what are your choices?
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How should I handle credit card debt? Using only the information provided in the context block, provide the answer in a bullet point list, bolding the reasoning keyword and following it with a description in unbolded text like this: * **Reasoning Keyword**: Explanation.... Your First Step—Making a Financial Plan What are the things you want to save and invest for? • a home • a car • an education • a comfortable retirement • your children • medical or other emergencies • periods of unemployment • caring for parents Make your own list and then think about which goals are the most important to you. List your most important goals first. Decide how many years you have to meet each specific goal, because when you save or invest you’ll need to find a savings or investment option that fits your time frame for meeting each goal. Many tools exist to help you put your financial plan together. You’ll find a wealth of information, including calculators and links to non-commercial resources at Investor.gov. KNOW YOUR CURRENT FINANCIAL SITUATION Sit down and take an honest look at your entire financial situation. You can never take a journey without knowing where you’re starting from, and a journey to financial security is no different. You’ll need to figure out on paper your current situation—what you own and what you owe. You’ll be creating a “net worth statement.” On one side of the page, list what you own. These are your “assets.” And on the other side list what you owe other people, your “liabilities” or debts. Subtract your liabilities from your assets. If your assets are larger than your liabilities, you have a “positive” net worth. If your liabilities are greater than your assets, you have a “negative” net worth. You’ll want to update your “net worth statement” every year to keep track of how you are doing. Don’t be discouraged if you have a negative net worth. If you follow a plan to get into a positive position, you’re doing the right thing. KNOW YOUR INCOME AND EXPENSES The next step is to keep track of your income and your expenses for every month. Write down what you and others in your family earn, and then your monthly expenses. PAY YOURSELF OR YOUR FAMILY FIRST Include a category for savings and investing. What are you paying yourself every month? Many people get into the habit of saving and investing by following this advice: always pay yourself or your family first. Many people find it easier to pay themselves first if they allow their bank to automatically remove money from their paycheck and deposit it into a savings or investment account. Likely even better, for tax purposes, is to participate in an employer-sponsored retirement plan such as a 401(k), 403(b), or 457(b). These plans will typically not only automatically deduct money from your paycheck, but will immediately reduce the taxes you are paying. Additionally, in many plans the employer matches some or all of your contribution. When your employer does that, it’s offering “free money.” Any time you have automatic deductions made from your paycheck or bank account, you’ll increase the chances of being able to stick to your plan and to realize your goals. FINDING MONEY TO SAVE OR INVEST If you are spending all your income, and never have money to save or invest, you’ll need to look for ways to cut back on your expenses. When you watch where you spend your money, you will be surprised how small everyday expenses that you can do without add up over a year. Small Savings Add Up to Big Money How much does a cup of coffee cost you? If you buy a cup of coffee every day for $1.00 (an awfully good price for a decent cup of coffee, nowadays), that adds up to $365.00 a year. If you saved that $365.00 for just one year, and put it into a savings account or investment that earns 5% a year, it would grow to $465.84 by the end of 5 years, and by the end of 30 years, to $1,577.50. That’s the power of “compounding.” With compound interest, you earn interest on the money you save and on the interest that money earns. Over time, even a small amount saved can add up to big money. If you are willing to watch what you spend and look for little ways to save on a regular schedule, you can make money grow. You just did it with one cup of coffee. If a small cup of coffee can make such a huge difference, start looking at how you could make your money grow if you decided to spend less on other things and save those extra dollars. If you buy on impulse, make a rule that you’ll always wait 24 hours to buy anything. You may lose your desire to buy it after a day. And try emptying your pockets and wallet of spare change at the end of each day. You’ll be surprised how quickly those nickels and dimes add up! PAY OFF CREDIT CARD OR OTHER HIGH INTEREST DEBT Speaking of things adding up, few investment strategies pay off as well as, or with less risk than, merely paying off all high interest debt you may have. Many people have wallets filled with credit cards, some of which they’ve “maxed out” (meaning they’ve spent up to their credit limit). Credit cards can make it seem easy to buy expensive things when you don’t have the cash in your pocket—or in the bank. But credit cards aren’t free money. Most credit cards charge high interest rates—as much as 18 percent or more—if you don’t pay off your balance in full each month. If you owe money on your credit cards, the wisest thing you can do is pay off the balance in full as quickly as possible. Virtually no investment will give you the high returns you’ll need to keep pace with an 18 percent interest charge. That’s why you’re better off eliminating all credit card debt before investing savings. Once you’ve paid off your credit cards, you can budget your money and begin to save and invest. Here are some tips for avoiding credit card debt: Put Away the Plastic Don’t use a credit card unless your debt is at a manageable level and you know you’ll have the money to pay the bill when it arrives. Know What You Owe It’s easy to forget how much you’ve charged on your credit card. Every time you use a credit card, write down how much you have spent and figure out how much you’ll have to pay that month. If you know you won’t be able to pay your balance in full, try to figure out how much you can pay each month and how long it’ll take to pay the balance in full. Pay Off the Card with the Highest Rate If you’ve got unpaid balances on several credit cards, you should first pay down the card that charges the highest rate. Pay as much as you can toward that debt each month until your balance is once again zero, while still paying the minimum on your other cards. The same advice goes for any other high interest debt (about 8% or above) which does not offer the tax advantages of, for example, a mortgage. Now, once you have paid off those credit cards and begun to set aside some money to save and invest, what are your choices?
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Using only the information provided in the context block, provide the answer in a bullet point list, bolding the reasoning keyword and following it with a description in unbolded text like this: * **Reasoning Keyword**: Explanation....
EVIDENCE:
Your First Step—Making a Financial Plan What are the things you want to save and invest for? • a home • a car • an education • a comfortable retirement • your children • medical or other emergencies • periods of unemployment • caring for parents Make your own list and then think about which goals are the most important to you. List your most important goals first. Decide how many years you have to meet each specific goal, because when you save or invest you’ll need to find a savings or investment option that fits your time frame for meeting each goal. Many tools exist to help you put your financial plan together. You’ll find a wealth of information, including calculators and links to non-commercial resources at Investor.gov. KNOW YOUR CURRENT FINANCIAL SITUATION Sit down and take an honest look at your entire financial situation. You can never take a journey without knowing where you’re starting from, and a journey to financial security is no different. You’ll need to figure out on paper your current situation—what you own and what you owe. You’ll be creating a “net worth statement.” On one side of the page, list what you own. These are your “assets.” And on the other side list what you owe other people, your “liabilities” or debts. Subtract your liabilities from your assets. If your assets are larger than your liabilities, you have a “positive” net worth. If your liabilities are greater than your assets, you have a “negative” net worth. You’ll want to update your “net worth statement” every year to keep track of how you are doing. Don’t be discouraged if you have a negative net worth. If you follow a plan to get into a positive position, you’re doing the right thing. KNOW YOUR INCOME AND EXPENSES The next step is to keep track of your income and your expenses for every month. Write down what you and others in your family earn, and then your monthly expenses. PAY YOURSELF OR YOUR FAMILY FIRST Include a category for savings and investing. What are you paying yourself every month? Many people get into the habit of saving and investing by following this advice: always pay yourself or your family first. Many people find it easier to pay themselves first if they allow their bank to automatically remove money from their paycheck and deposit it into a savings or investment account. Likely even better, for tax purposes, is to participate in an employer-sponsored retirement plan such as a 401(k), 403(b), or 457(b). These plans will typically not only automatically deduct money from your paycheck, but will immediately reduce the taxes you are paying. Additionally, in many plans the employer matches some or all of your contribution. When your employer does that, it’s offering “free money.” Any time you have automatic deductions made from your paycheck or bank account, you’ll increase the chances of being able to stick to your plan and to realize your goals. FINDING MONEY TO SAVE OR INVEST If you are spending all your income, and never have money to save or invest, you’ll need to look for ways to cut back on your expenses. When you watch where you spend your money, you will be surprised how small everyday expenses that you can do without add up over a year. Small Savings Add Up to Big Money How much does a cup of coffee cost you? If you buy a cup of coffee every day for $1.00 (an awfully good price for a decent cup of coffee, nowadays), that adds up to $365.00 a year. If you saved that $365.00 for just one year, and put it into a savings account or investment that earns 5% a year, it would grow to $465.84 by the end of 5 years, and by the end of 30 years, to $1,577.50. That’s the power of “compounding.” With compound interest, you earn interest on the money you save and on the interest that money earns. Over time, even a small amount saved can add up to big money. If you are willing to watch what you spend and look for little ways to save on a regular schedule, you can make money grow. You just did it with one cup of coffee. If a small cup of coffee can make such a huge difference, start looking at how you could make your money grow if you decided to spend less on other things and save those extra dollars. If you buy on impulse, make a rule that you’ll always wait 24 hours to buy anything. You may lose your desire to buy it after a day. And try emptying your pockets and wallet of spare change at the end of each day. You’ll be surprised how quickly those nickels and dimes add up! PAY OFF CREDIT CARD OR OTHER HIGH INTEREST DEBT Speaking of things adding up, few investment strategies pay off as well as, or with less risk than, merely paying off all high interest debt you may have. Many people have wallets filled with credit cards, some of which they’ve “maxed out” (meaning they’ve spent up to their credit limit). Credit cards can make it seem easy to buy expensive things when you don’t have the cash in your pocket—or in the bank. But credit cards aren’t free money. Most credit cards charge high interest rates—as much as 18 percent or more—if you don’t pay off your balance in full each month. If you owe money on your credit cards, the wisest thing you can do is pay off the balance in full as quickly as possible. Virtually no investment will give you the high returns you’ll need to keep pace with an 18 percent interest charge. That’s why you’re better off eliminating all credit card debt before investing savings. Once you’ve paid off your credit cards, you can budget your money and begin to save and invest. Here are some tips for avoiding credit card debt: Put Away the Plastic Don’t use a credit card unless your debt is at a manageable level and you know you’ll have the money to pay the bill when it arrives. Know What You Owe It’s easy to forget how much you’ve charged on your credit card. Every time you use a credit card, write down how much you have spent and figure out how much you’ll have to pay that month. If you know you won’t be able to pay your balance in full, try to figure out how much you can pay each month and how long it’ll take to pay the balance in full. Pay Off the Card with the Highest Rate If you’ve got unpaid balances on several credit cards, you should first pay down the card that charges the highest rate. Pay as much as you can toward that debt each month until your balance is once again zero, while still paying the minimum on your other cards. The same advice goes for any other high interest debt (about 8% or above) which does not offer the tax advantages of, for example, a mortgage. Now, once you have paid off those credit cards and begun to set aside some money to save and invest, what are your choices?
USER:
How should I handle credit card debt?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 36 | 7 | 1,215 | null | 786 |
This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.
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Aside from meetings with each other, what are some shared responsibilities of both family and administrators?
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Family’s Responsibility • Notify the school of the child’s allergies before the student attends classes. • Work with the school team to develop an individualized healthcare plan (IHP) that accommodates the child’s needs throughout the school including in the classroom, in the cafeteria, in after-care programs, during school-sponsored activities, and on the school bus, as well as an Emergency Action Plan. • Provide current written medical documentation, instructions, and medications as directed by your child’s HCP. Include a photo of the child for identification safety if requested. Additional district forms will need to be completed by the student, parent, and HCP if the student self-carries and administers medication(s). These forms must be renewed yearly or more often if changes in your child’s condition or HCP orders occur. • Sign release of information forms to allow communication between the school district and your child’s HCP to allow for the best possible care for your child. • Provide adequate properly labeled medications for your child and backup medication in the school office if your child self-administers their medication. Replace medications after use or upon expiration. • Educate the child in the self-management of their food allergy including: o recognition of safe and unsafe foods o recognition of other allergen containing materials such as art or science supplies, band aids, or other school supplies o strategies for avoiding allergen exposure such as peer pressure and engaging in high-risk activities that would increase allergen exposure o identification, recognizing, and describing symptoms of allergic reactions o how and when to tell an adult they may be having an allergy-related problem o how to read food and other product labels for allergen identification (age appropriate) o knowledge of school policies and procedures, including responsibilities in self-carrying and administration of medications when appropriate o practice drills and role-playing • Provide emergency contact information and keep this up to date when changes occur. • Notify the school nurse if changes in the IHP/EAP are needed. • Debrief with school staff, the student’s HCP, and the student (age appropriate) after a reaction has occurred. • Inform school administration, school nurse, or counselor if bullying or teasing occurs. Approve a safe classroom treat alternative to ensure student will not be excluded from any classroom or school sponsored activity involving food. • Submit to food service a signed “Medical Statement for Student Requiring Special Meals” form. School’s/Administrator’s Responsibilities • Be knowledgeable about and follow applicable federal laws including ADA, IDEA, Section 504, and FERPA and any state laws or district policies that apply. • Support and oversee faculty, staff, students, and parent/guardian in implementing all aspects of the management plan. • Ensure students with allergies are not excluded from school activities due to their health condition. • Identify a core team of, but not limited to, school nurse, teacher, principal, school food service manager, transportation director, counselor (if available) to work with parents and the student (age appropriate) to establish a prevention plan distinguishing between buildingwide, classroom and individual approaches to allergy prevention and management. Changes to the prevention plan to promote revisions in allergy management should be made with core team participation. • Provide input to the core team in the development and implementation of related policies and procedures. Ensure implementation of these policies and procedures. • Ensure annual training of all staff interacting with the student on a regular basis to: understand the student’s specific allergy(s), recognize allergic symptoms, and know actions to take in an emergency (including epinephrine administration as directed). Work with school staff to eliminate the use of potential allergens in the student’s meals, educational tools, arts and crafts projects. All school staff are to be annually trained by the school nurse in general information regarding recognition, prevention and response to allergic reactions. • Ensure protocols are in place for training substitute staff who may have responsibility for a student with a life-threatening allergy including teachers, school nurses, nutrition services, recess and/or lunch aides, bus driver, and other specialists. o Include any responsibilities expected of these individuals to implement specific IHP/EAP or school-specific food allergy policies. Contingency plans must be in place if a substitute cannot be trained to handle an allergy emergency. • Assure for the age-appropriate education of all students including potential causes of allergic reactions, information on avoiding allergens, signs and symptoms of allergic reactions and simple steps students can take to keep classmates safe. • Provide for practice of the Emergency Action Plan before an allergic reaction occurs to assure the efficiency/effectiveness of the plans. Coordinate with the school nurse to assure medications are appropriately stored, and an emergency kit(s) is available and accessible containing a current standing order for epinephrine from an HCP (as allowed by school district policy). • Assure that protocols permit students to carry their own epinephrine after approval from the student’s HCP, parent, and school nurse. Work with the school nurse in designation of school personnel who are properly trained to administer emergency medications in accordance with all applicable state laws and school district policy during the school day and all school activities (including field trips). • Ensure posting of a list of Cardio Pulmonary Resuscitation (CPR) certified staff in the building and a system for communicating with them and eliciting an immediate response in emergencies. • Ensure systems are in place to inform the parent/guardian(s) if any student experiences an allergic reaction at school. • Review policies/prevention plan with the core team members, parents/guardians, student (age appropriate), and HCP as appropriate after a reaction has occurred. • Work with the district transportation director to assure that school bus driver training includes symptom awareness and actions to be taken if a reaction occurs. • Recommend that all buses have communication devices in case of an emergency. • Enforce a “no eating” policy on school buses with exceptions made only to accommodate special needs under federal or similar laws, or school district policy. • Encourage a “no sharing” policy in lunchrooms and provide for the identification of “allergyaware” tables. Ensure surfaces are cleaned according to district policy/procedures to avoid exposure by cross contamination. • Discuss field trips with the family to decide appropriate strategies for managing the student’s allergy(s). • Follow federal/state/district laws and regulations regarding sharing medical information about the student. • Provide safe environments, both physically and emotionally (develop and enforce strict antibullying policies). • Ensure after-hours users of the school building are informed of and following all restrictions and rules impacting the use of common spaces and individual classrooms. • Discourage school staff from the use of food or other allergen products such as latex balloons as a reward for school activities. The building administrator must approve any food preparation or consumption in any instructional area.
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System instructions: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. question: Aside from meetings with each other, what are some shared responsibilities of both family and administrators? context block: Family’s Responsibility • Notify the school of the child’s allergies before the student attends classes. • Work with the school team to develop an individualized healthcare plan (IHP) that accommodates the child’s needs throughout the school including in the classroom, in the cafeteria, in after-care programs, during school-sponsored activities, and on the school bus, as well as an Emergency Action Plan. • Provide current written medical documentation, instructions, and medications as directed by your child’s HCP. Include a photo of the child for identification safety if requested. Additional district forms will need to be completed by the student, parent, and HCP if the student self-carries and administers medication(s). These forms must be renewed yearly or more often if changes in your child’s condition or HCP orders occur. • Sign release of information forms to allow communication between the school district and your child’s HCP to allow for the best possible care for your child. • Provide adequate properly labeled medications for your child and backup medication in the school office if your child self-administers their medication. Replace medications after use or upon expiration. • Educate the child in the self-management of their food allergy including: o recognition of safe and unsafe foods o recognition of other allergen containing materials such as art or science supplies, band aids, or other school supplies o strategies for avoiding allergen exposure such as peer pressure and engaging in high-risk activities that would increase allergen exposure o identification, recognizing, and describing symptoms of allergic reactions o how and when to tell an adult they may be having an allergy-related problem o how to read food and other product labels for allergen identification (age appropriate) o knowledge of school policies and procedures, including responsibilities in self-carrying and administration of medications when appropriate o practice drills and role-playing • Provide emergency contact information and keep this up to date when changes occur. • Notify the school nurse if changes in the IHP/EAP are needed. • Debrief with school staff, the student’s HCP, and the student (age appropriate) after a reaction has occurred. • Inform school administration, school nurse, or counselor if bullying or teasing occurs. Approve a safe classroom treat alternative to ensure student will not be excluded from any classroom or school sponsored activity involving food. • Submit to food service a signed “Medical Statement for Student Requiring Special Meals” form. School’s/Administrator’s Responsibilities • Be knowledgeable about and follow applicable federal laws including ADA, IDEA, Section 504, and FERPA and any state laws or district policies that apply. • Support and oversee faculty, staff, students, and parent/guardian in implementing all aspects of the management plan. • Ensure students with allergies are not excluded from school activities due to their health condition. • Identify a core team of, but not limited to, school nurse, teacher, principal, school food service manager, transportation director, counselor (if available) to work with parents and the student (age appropriate) to establish a prevention plan distinguishing between buildingwide, classroom and individual approaches to allergy prevention and management. Changes to the prevention plan to promote revisions in allergy management should be made with core team participation. • Provide input to the core team in the development and implementation of related policies and procedures. Ensure implementation of these policies and procedures. • Ensure annual training of all staff interacting with the student on a regular basis to: understand the student’s specific allergy(s), recognize allergic symptoms, and know actions to take in an emergency (including epinephrine administration as directed). Work with school staff to eliminate the use of potential allergens in the student’s meals, educational tools, arts and crafts projects. All school staff are to be annually trained by the school nurse in general information regarding recognition, prevention and response to allergic reactions. • Ensure protocols are in place for training substitute staff who may have responsibility for a student with a life-threatening allergy including teachers, school nurses, nutrition services, recess and/or lunch aides, bus driver, and other specialists. o Include any responsibilities expected of these individuals to implement specific IHP/EAP or school-specific food allergy policies. Contingency plans must be in place if a substitute cannot be trained to handle an allergy emergency. • Assure for the age-appropriate education of all students including potential causes of allergic reactions, information on avoiding allergens, signs and symptoms of allergic reactions and simple steps students can take to keep classmates safe. • Provide for practice of the Emergency Action Plan before an allergic reaction occurs to assure the efficiency/effectiveness of the plans. Coordinate with the school nurse to assure medications are appropriately stored, and an emergency kit(s) is available and accessible containing a current standing order for epinephrine from an HCP (as allowed by school district policy). • Assure that protocols permit students to carry their own epinephrine after approval from the student’s HCP, parent, and school nurse. Work with the school nurse in designation of school personnel who are properly trained to administer emergency medications in accordance with all applicable state laws and school district policy during the school day and all school activities (including field trips). • Ensure posting of a list of Cardio Pulmonary Resuscitation (CPR) certified staff in the building and a system for communicating with them and eliciting an immediate response in emergencies. • Ensure systems are in place to inform the parent/guardian(s) if any student experiences an allergic reaction at school. • Review policies/prevention plan with the core team members, parents/guardians, student (age appropriate), and HCP as appropriate after a reaction has occurred. • Work with the district transportation director to assure that school bus driver training includes symptom awareness and actions to be taken if a reaction occurs. • Recommend that all buses have communication devices in case of an emergency. • Enforce a “no eating” policy on school buses with exceptions made only to accommodate special needs under federal or similar laws, or school district policy. • Encourage a “no sharing” policy in lunchrooms and provide for the identification of “allergyaware” tables. Ensure surfaces are cleaned according to district policy/procedures to avoid exposure by cross contamination. • Discuss field trips with the family to decide appropriate strategies for managing the student’s allergy(s). • Follow federal/state/district laws and regulations regarding sharing medical information about the student. • Provide safe environments, both physically and emotionally (develop and enforce strict antibullying policies). • Ensure after-hours users of the school building are informed of and following all restrictions and rules impacting the use of common spaces and individual classrooms. • Discourage school staff from the use of food or other allergen products such as latex balloons as a reward for school activities. The building administrator must approve any food preparation or consumption in any instructional area.
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This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.
EVIDENCE:
Family’s Responsibility • Notify the school of the child’s allergies before the student attends classes. • Work with the school team to develop an individualized healthcare plan (IHP) that accommodates the child’s needs throughout the school including in the classroom, in the cafeteria, in after-care programs, during school-sponsored activities, and on the school bus, as well as an Emergency Action Plan. • Provide current written medical documentation, instructions, and medications as directed by your child’s HCP. Include a photo of the child for identification safety if requested. Additional district forms will need to be completed by the student, parent, and HCP if the student self-carries and administers medication(s). These forms must be renewed yearly or more often if changes in your child’s condition or HCP orders occur. • Sign release of information forms to allow communication between the school district and your child’s HCP to allow for the best possible care for your child. • Provide adequate properly labeled medications for your child and backup medication in the school office if your child self-administers their medication. Replace medications after use or upon expiration. • Educate the child in the self-management of their food allergy including: o recognition of safe and unsafe foods o recognition of other allergen containing materials such as art or science supplies, band aids, or other school supplies o strategies for avoiding allergen exposure such as peer pressure and engaging in high-risk activities that would increase allergen exposure o identification, recognizing, and describing symptoms of allergic reactions o how and when to tell an adult they may be having an allergy-related problem o how to read food and other product labels for allergen identification (age appropriate) o knowledge of school policies and procedures, including responsibilities in self-carrying and administration of medications when appropriate o practice drills and role-playing • Provide emergency contact information and keep this up to date when changes occur. • Notify the school nurse if changes in the IHP/EAP are needed. • Debrief with school staff, the student’s HCP, and the student (age appropriate) after a reaction has occurred. • Inform school administration, school nurse, or counselor if bullying or teasing occurs. Approve a safe classroom treat alternative to ensure student will not be excluded from any classroom or school sponsored activity involving food. • Submit to food service a signed “Medical Statement for Student Requiring Special Meals” form. School’s/Administrator’s Responsibilities • Be knowledgeable about and follow applicable federal laws including ADA, IDEA, Section 504, and FERPA and any state laws or district policies that apply. • Support and oversee faculty, staff, students, and parent/guardian in implementing all aspects of the management plan. • Ensure students with allergies are not excluded from school activities due to their health condition. • Identify a core team of, but not limited to, school nurse, teacher, principal, school food service manager, transportation director, counselor (if available) to work with parents and the student (age appropriate) to establish a prevention plan distinguishing between buildingwide, classroom and individual approaches to allergy prevention and management. Changes to the prevention plan to promote revisions in allergy management should be made with core team participation. • Provide input to the core team in the development and implementation of related policies and procedures. Ensure implementation of these policies and procedures. • Ensure annual training of all staff interacting with the student on a regular basis to: understand the student’s specific allergy(s), recognize allergic symptoms, and know actions to take in an emergency (including epinephrine administration as directed). Work with school staff to eliminate the use of potential allergens in the student’s meals, educational tools, arts and crafts projects. All school staff are to be annually trained by the school nurse in general information regarding recognition, prevention and response to allergic reactions. • Ensure protocols are in place for training substitute staff who may have responsibility for a student with a life-threatening allergy including teachers, school nurses, nutrition services, recess and/or lunch aides, bus driver, and other specialists. o Include any responsibilities expected of these individuals to implement specific IHP/EAP or school-specific food allergy policies. Contingency plans must be in place if a substitute cannot be trained to handle an allergy emergency. • Assure for the age-appropriate education of all students including potential causes of allergic reactions, information on avoiding allergens, signs and symptoms of allergic reactions and simple steps students can take to keep classmates safe. • Provide for practice of the Emergency Action Plan before an allergic reaction occurs to assure the efficiency/effectiveness of the plans. Coordinate with the school nurse to assure medications are appropriately stored, and an emergency kit(s) is available and accessible containing a current standing order for epinephrine from an HCP (as allowed by school district policy). • Assure that protocols permit students to carry their own epinephrine after approval from the student’s HCP, parent, and school nurse. Work with the school nurse in designation of school personnel who are properly trained to administer emergency medications in accordance with all applicable state laws and school district policy during the school day and all school activities (including field trips). • Ensure posting of a list of Cardio Pulmonary Resuscitation (CPR) certified staff in the building and a system for communicating with them and eliciting an immediate response in emergencies. • Ensure systems are in place to inform the parent/guardian(s) if any student experiences an allergic reaction at school. • Review policies/prevention plan with the core team members, parents/guardians, student (age appropriate), and HCP as appropriate after a reaction has occurred. • Work with the district transportation director to assure that school bus driver training includes symptom awareness and actions to be taken if a reaction occurs. • Recommend that all buses have communication devices in case of an emergency. • Enforce a “no eating” policy on school buses with exceptions made only to accommodate special needs under federal or similar laws, or school district policy. • Encourage a “no sharing” policy in lunchrooms and provide for the identification of “allergyaware” tables. Ensure surfaces are cleaned according to district policy/procedures to avoid exposure by cross contamination. • Discuss field trips with the family to decide appropriate strategies for managing the student’s allergy(s). • Follow federal/state/district laws and regulations regarding sharing medical information about the student. • Provide safe environments, both physically and emotionally (develop and enforce strict antibullying policies). • Ensure after-hours users of the school building are informed of and following all restrictions and rules impacting the use of common spaces and individual classrooms. • Discourage school staff from the use of food or other allergen products such as latex balloons as a reward for school activities. The building administrator must approve any food preparation or consumption in any instructional area.
USER:
Aside from meetings with each other, what are some shared responsibilities of both family and administrators?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 28 | 16 | 1,121 | null | 258 |
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
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Give me a bullet-point timeline showing how Vuori has grown over the past ten years. Keep each bullet point under 20 words, and be sure to mention how their product line has changed over the years.
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Vuori, The Athleisure Brand Valued At $4 Billion, Is Halfway To Opening 100 Stores By 2026 Say athleisurewear and one name comes immediately to mind: Lululemon. For athletic wear, one name dominates the conversation, NikeNKE -1%, with honorable mention to Adidas and Puma. Vuori is far behind the leaders in both realms, but then the market share leaders had a big head start. Joe Kudla founded Vuori only in 2014, while Lululemon got started in 1998 and Nike back in 1964. But Vuori aims to become a brand as big if not bigger than those market leaders: “Vuori wants to be a relevant household name 20 years from now. We have no interest in growing really, really fast just to hit some number and then falling out of favor with consumers or having a major quality issue,” Kudla shared with Retail Dive. Slow And Steady Wins The Race Kudla has followed a methodical path to growth by correcting mistakes and filling whitespace left by the big guys. That strategy propelled it forward fast to reach a valuation of $4 billion in late 2021 after receiving $400 million in venture funding by Softback Investment Advisors and Trinity West Venture, according to Pitchbook. Now, Bloomberg reports it is considering an IPO this year, though the company has not confirmed the rumors. Nonetheless, Kudla has accomplished much with Vuori in its ten short years. Before becoming an entrepreneur, he was working as an accountant and had little fashion experience, though he did a modeling stint for a few years, which gave him a passion for the business. It was as an athlete, particularly his mountain climbing experience, where he found the business opportunity: filling the performance gap in men’s athletic apparel. And the company’s name came from those roots: Vuori is the Finnish word for “mountain.” The brand’s first product was a simple pair of men’s shorts made from super-soft, high-quality fabrics that look good enough to wear around town, but also provide support and wick away moisture when running the track. And whether in town or on the track, the shorts were super-comfortable to wear. Vuori became an instant hit with athletes who valued its superior quality and didn’t want to be a walking – or running – billboard for another brand. By year two, it was generating $1 million in DTC revenues and even more remarkable for a startup, it was profitable, credited to Kudla’s accounting background that kept him fixated on the books. “We never acquired a customer at a loss,” Kudla shared with Fast Company. “We were hyper-focused on cash flow, and getting the unit economics of a transaction profitable.” Reaching Further Growing buzz about the brand put it on REI’s radar, which after testing it in a few stores, found such strong customer affinity that it put it into more than 150 locations. By 2018, Vuori was generating upwards of $30 million in sales, much of it coming from wholesale distribution, which generates less revenue than DTC but gives a brand credibility and added exposure by having a respected retailer choose to carry it. Currently, it’s retail partners include NordstromJWN -1.3%, Selfridges, Harrods, Equinox Gyms, Barry’s Bootcamp and numerous specialty independent retailers. It was also in 2018 that Vuori launched into women’s apparel, reaching the other half of the athletic apparel market, estimated at $158 billion in North America in 2023 and expected to grow 6% CAGR through 2027, according to McKinsey. That combined with opening its first store in hometown Encinitas, CA got the brand’s flywheel humming. Currently, it operates over 50 stores in 17 states and internationally in London, Shanghai and Seoul, up from just four in 2019 all located in California. Plans are to open 20 to 25 stores over the next two or so years to reach 100 by 2026. Tasked with that mission is vice president of retail Catherine Pike who joined the company in 2019. A lawyer by training, Pike came from fitness franchiser Fit4Mom where she led franchise operations and before that, she spent eight years with Lululemon, rising from local store to regional manager.
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Give me a bullet-point timeline showing how Vuori has grown over the past ten years. Keep each bullet point under 20 words, and be sure to mention how their product line has changed over the years. {passage 0} ========== Vuori, The Athleisure Brand Valued At $4 Billion, Is Halfway To Opening 100 Stores By 2026 Say athleisurewear and one name comes immediately to mind: Lululemon. For athletic wear, one name dominates the conversation, NikeNKE -1%, with honorable mention to Adidas and Puma. Vuori is far behind the leaders in both realms, but then the market share leaders had a big head start. Joe Kudla founded Vuori only in 2014, while Lululemon got started in 1998 and Nike back in 1964. But Vuori aims to become a brand as big if not bigger than those market leaders: “Vuori wants to be a relevant household name 20 years from now. We have no interest in growing really, really fast just to hit some number and then falling out of favor with consumers or having a major quality issue,” Kudla shared with Retail Dive. Slow And Steady Wins The Race Kudla has followed a methodical path to growth by correcting mistakes and filling whitespace left by the big guys. That strategy propelled it forward fast to reach a valuation of $4 billion in late 2021 after receiving $400 million in venture funding by Softback Investment Advisors and Trinity West Venture, according to Pitchbook. Now, Bloomberg reports it is considering an IPO this year, though the company has not confirmed the rumors. Nonetheless, Kudla has accomplished much with Vuori in its ten short years. Before becoming an entrepreneur, he was working as an accountant and had little fashion experience, though he did a modeling stint for a few years, which gave him a passion for the business. It was as an athlete, particularly his mountain climbing experience, where he found the business opportunity: filling the performance gap in men’s athletic apparel. And the company’s name came from those roots: Vuori is the Finnish word for “mountain.” The brand’s first product was a simple pair of men’s shorts made from super-soft, high-quality fabrics that look good enough to wear around town, but also provide support and wick away moisture when running the track. And whether in town or on the track, the shorts were super-comfortable to wear. Vuori became an instant hit with athletes who valued its superior quality and didn’t want to be a walking – or running – billboard for another brand. By year two, it was generating $1 million in DTC revenues and even more remarkable for a startup, it was profitable, credited to Kudla’s accounting background that kept him fixated on the books. “We never acquired a customer at a loss,” Kudla shared with Fast Company. “We were hyper-focused on cash flow, and getting the unit economics of a transaction profitable.” Reaching Further Growing buzz about the brand put it on REI’s radar, which after testing it in a few stores, found such strong customer affinity that it put it into more than 150 locations. By 2018, Vuori was generating upwards of $30 million in sales, much of it coming from wholesale distribution, which generates less revenue than DTC but gives a brand credibility and added exposure by having a respected retailer choose to carry it. Currently, it’s retail partners include NordstromJWN -1.3%, Selfridges, Harrods, Equinox Gyms, Barry’s Bootcamp and numerous specialty independent retailers. It was also in 2018 that Vuori launched into women’s apparel, reaching the other half of the athletic apparel market, estimated at $158 billion in North America in 2023 and expected to grow 6% CAGR through 2027, according to McKinsey. That combined with opening its first store in hometown Encinitas, CA got the brand’s flywheel humming. Currently, it operates over 50 stores in 17 states and internationally in London, Shanghai and Seoul, up from just four in 2019 all located in California. Plans are to open 20 to 25 stores over the next two or so years to reach 100 by 2026. Tasked with that mission is vice president of retail Catherine Pike who joined the company in 2019. A lawyer by training, Pike came from fitness franchiser Fit4Mom where she led franchise operations and before that, she spent eight years with Lululemon, rising from local store to regional manager. https://www.forbes.com/sites/pamdanziger/2024/02/25/vuori-the-athleisure-brand-valued-at-4-billion-is-halfway-to-opening-100-stores-by-2026/
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{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
EVIDENCE:
Vuori, The Athleisure Brand Valued At $4 Billion, Is Halfway To Opening 100 Stores By 2026 Say athleisurewear and one name comes immediately to mind: Lululemon. For athletic wear, one name dominates the conversation, NikeNKE -1%, with honorable mention to Adidas and Puma. Vuori is far behind the leaders in both realms, but then the market share leaders had a big head start. Joe Kudla founded Vuori only in 2014, while Lululemon got started in 1998 and Nike back in 1964. But Vuori aims to become a brand as big if not bigger than those market leaders: “Vuori wants to be a relevant household name 20 years from now. We have no interest in growing really, really fast just to hit some number and then falling out of favor with consumers or having a major quality issue,” Kudla shared with Retail Dive. Slow And Steady Wins The Race Kudla has followed a methodical path to growth by correcting mistakes and filling whitespace left by the big guys. That strategy propelled it forward fast to reach a valuation of $4 billion in late 2021 after receiving $400 million in venture funding by Softback Investment Advisors and Trinity West Venture, according to Pitchbook. Now, Bloomberg reports it is considering an IPO this year, though the company has not confirmed the rumors. Nonetheless, Kudla has accomplished much with Vuori in its ten short years. Before becoming an entrepreneur, he was working as an accountant and had little fashion experience, though he did a modeling stint for a few years, which gave him a passion for the business. It was as an athlete, particularly his mountain climbing experience, where he found the business opportunity: filling the performance gap in men’s athletic apparel. And the company’s name came from those roots: Vuori is the Finnish word for “mountain.” The brand’s first product was a simple pair of men’s shorts made from super-soft, high-quality fabrics that look good enough to wear around town, but also provide support and wick away moisture when running the track. And whether in town or on the track, the shorts were super-comfortable to wear. Vuori became an instant hit with athletes who valued its superior quality and didn’t want to be a walking – or running – billboard for another brand. By year two, it was generating $1 million in DTC revenues and even more remarkable for a startup, it was profitable, credited to Kudla’s accounting background that kept him fixated on the books. “We never acquired a customer at a loss,” Kudla shared with Fast Company. “We were hyper-focused on cash flow, and getting the unit economics of a transaction profitable.” Reaching Further Growing buzz about the brand put it on REI’s radar, which after testing it in a few stores, found such strong customer affinity that it put it into more than 150 locations. By 2018, Vuori was generating upwards of $30 million in sales, much of it coming from wholesale distribution, which generates less revenue than DTC but gives a brand credibility and added exposure by having a respected retailer choose to carry it. Currently, it’s retail partners include NordstromJWN -1.3%, Selfridges, Harrods, Equinox Gyms, Barry’s Bootcamp and numerous specialty independent retailers. It was also in 2018 that Vuori launched into women’s apparel, reaching the other half of the athletic apparel market, estimated at $158 billion in North America in 2023 and expected to grow 6% CAGR through 2027, according to McKinsey. That combined with opening its first store in hometown Encinitas, CA got the brand’s flywheel humming. Currently, it operates over 50 stores in 17 states and internationally in London, Shanghai and Seoul, up from just four in 2019 all located in California. Plans are to open 20 to 25 stores over the next two or so years to reach 100 by 2026. Tasked with that mission is vice president of retail Catherine Pike who joined the company in 2019. A lawyer by training, Pike came from fitness franchiser Fit4Mom where she led franchise operations and before that, she spent eight years with Lululemon, rising from local store to regional manager.
USER:
Give me a bullet-point timeline showing how Vuori has grown over the past ten years. Keep each bullet point under 20 words, and be sure to mention how their product line has changed over the years.
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 26 | 36 | 684 | null | 438 |
Write your answer using simple language and do not exceed 120 words. Replace all mention of the word technology with "tech." Please answer using only the information provided below. Do not use any external sources or prior knowledge to support your response.
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In well-functioning Standards Developing Organizations, how are ideas selected?
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What Standards Are and Why They Matter From computers and smartphones to cars and lightbulbs, societies rely on technology standards for everyday life. In the broadest sense, standards are the common and repeated use of rules, conditions, guidelines, or characteristics for products or related processes, practices, and production methods. They enable technology that is safe, universal, and interoperable. Standards define the requirements that make it possible for mobile phones sold in different countries to communicate across the world, for bank cards issued in one country to be recognized at ATMs in another, and for cars to run on fuel purchased from any gas station. Standards also help manage risk, security, safety, privacy, and quality in the development of new innovations. In short, good standards are good for business, good for consumers, and good for society. Standards Developing Organizations (SDOs) consist of experts from industry, academia, civil society groups, and government, all of whom share a common goal of ensuring safety, interoperability, and competition in a particular technology or technology application. In well functioning SDOs, ideas are selected not on the basis of the nationality, employer, or personality originating them, but instead on the basis of technical merit. Six principles govern the international standards development process: transparency, openness, impartiality and consensus, effectiveness and relevance, coherence, and a commitment to participation by low- and middle-income countries. The private sector has led U.S. engagement with SDOs for more than 100 years. An example of how this system works comes from the communications industry. Qualcomm Technologies provided the proposal in the 1990s that became the basis for all 3G standards, while NTT Docomo, a large mobile phone operator in Japan, provided the proposal that later became LTE, the predominant standard for wireless broadband communication for mobile devices and data terminals. This private sector leadership has come with significant assistance from government and academia. In 1901, the Congress established the National Bureau of Standards—which has since become the National Institute of Standards and Technology (NIST)—as the authoritative domestic measurement science research and standards laboratory. Not long after, five engineering societies and three Federal agencies banded together to establish a national non governmental body now known as the American National Standards Institute (ANSI). ANSI is a private, nonprofit organization that administers and coordinates the U.S. standardization system and is the sole U.S. representative to the International Organization for Standardization (ISO) and the International Electrotechnical Commission. Industry, consortia, and private-sector groups often complement the roles of NIST, ANSI, and ANSI-accredited SDOs, working together to develop standards to solve specific challenges. To date, this approach, supported by U.S. leadership, has fostered an effective and innovative system that has supercharged U.S. and global economic growth. In an era of rapid technological transformation and global scale, standards will continue to define and drive the markets of the future. Standards for CET—advanced technologies that are significant for U.S. competitiveness and national security - carry strategic significance. The United States will work with all nations committed to an open and transparent standards system to lead the way in these new arenas - just as we did with previous internet, wireless communications, and other digital standards. Failing to do so will risk the United States’—and the world’s—innovation, security, and prosperity. Standards for Critical and Emerging Technology The United States will prioritize efforts for standards development for a subset of CET that are essential for U.S. competitiveness and national security, including the following areas: • Communication and Networking Technologies, which are enabling dramatic changes in how consumers, businesses, and governments interact, and which will form the basis of tomorrow’s critical communications networks; • Semiconductors and Microelectronics, including Computing, Memory, and Storage Technologies, which affect every corner of the global economy, society, and government, and which power a panoply of innovations and capabilities; • Artificial Intelligence and Machine Learning, which promise transformative technologies and scientific breakthroughs across industries, but which must be developed in a trustworthy and risk-managed manner; • Biotechnologies, which will affect the health, agricultural, and industrial sectors of all nations, and which will need to be used safely and securely to support the health of our citizens, animals, and environment; • Positioning, Navigation, and Timing Services, which are a largely invisible utility for technology and infrastructure, including the electrical power grid, communications infrastructure and mobile devices, all modes of transportation, precision agriculture, weather forecasting, and emergency response; • Digital Identity Infrastructure and Distributed Ledger Technologies, which increasingly affect a range of key economic sectors; • Clean Energy Generation and Storage, which are critical to the generation, storage, distribution, and climate-friendly and efficient utilization of energy, and to the security of the technologies that support energy-producing plants; and • Quantum Information Technologies, which leverage quantum mechanics for the storage, transmission, manipulation, computing, or measurement of information, with major national security and economic implications. There are also specific applications of CET that departments and agencies have determined will impact our global economy and national security. The United States will focus standards development activities and outreach on these applications, which include: • Automated and Connected Infrastructure, such as smart communities, Internet of Things, and other novel applications; • Biobanking, which involves the collection, storage, and use of biological samples; • Automated, Connected, and Electrified Transportation, including automated and connected surface vehicles of many types and unmanned aircraft systems, many of which may be electric vehicles (EVs), along with the safe and efficient integration into smart communities and the transportation system as a whole, including standards to integrate EVs with the electrical grid and charging infrastructure; • Critical Minerals Supply Chains, where we will promote standards that support increased sustainable extraction of critical minerals necessary to manufacture renewable energy technologies, semiconductors, and EVs; • Cybersecurity and Privacy, which are cross-cutting issues that are critical to enabling the development and deployment of emerging technologies and promote the free flow of data and ideas with trust; and • Carbon Capture, Removal, Utilization and Storage, which can build on evolving standards for CO2 storage, and emerging standards for point source carbon capture, removal, and utilization, especially as those standards relate to monitoring and verification.
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In well-functioning Standards Developing Organizations, how are ideas selected? Write your answer using simple language and do not exceed 120 words. Replace all mention of the word technology with "tech." Please answer using only the information provided below. Do not use any external sources or prior knowledge to support your response. What Standards Are and Why They Matter From computers and smartphones to cars and lightbulbs, societies rely on technology standards for everyday life. In the broadest sense, standards are the common and repeated use of rules, conditions, guidelines, or characteristics for products or related processes, practices, and production methods. They enable technology that is safe, universal, and interoperable. Standards define the requirements that make it possible for mobile phones sold in different countries to communicate across the world, for bank cards issued in one country to be recognized at ATMs in another, and for cars to run on fuel purchased from any gas station. Standards also help manage risk, security, safety, privacy, and quality in the development of new innovations. In short, good standards are good for business, good for consumers, and good for society. Standards Developing Organizations (SDOs) consist of experts from industry, academia, civil society groups, and government, all of whom share a common goal of ensuring safety, interoperability, and competition in a particular technology or technology application. In well functioning SDOs, ideas are selected not on the basis of the nationality, employer, or personality originating them, but instead on the basis of technical merit. Six principles govern the international standards development process: transparency, openness, impartiality and consensus, effectiveness and relevance, coherence, and a commitment to participation by low- and middle-income countries. The private sector has led U.S. engagement with SDOs for more than 100 years. An example of how this system works comes from the communications industry. Qualcomm Technologies provided the proposal in the 1990s that became the basis for all 3G standards, while NTT Docomo, a large mobile phone operator in Japan, provided the proposal that later became LTE, the predominant standard for wireless broadband communication for mobile devices and data terminals. This private sector leadership has come with significant assistance from government and academia. In 1901, the Congress established the National Bureau of Standards—which has since become the National Institute of Standards and Technology (NIST)—as the authoritative domestic measurement science research and standards laboratory. Not long after, five engineering societies and three Federal agencies banded together to establish a national non governmental body now known as the American National Standards Institute (ANSI). ANSI is a private, nonprofit organization that administers and coordinates the U.S. standardization system and is the sole U.S. representative to the International Organization for Standardization (ISO) and the International Electrotechnical Commission. Industry, consortia, and private-sector groups often complement the roles of NIST, ANSI, and ANSI-accredited SDOs, working together to develop standards to solve specific challenges. To date, this approach, supported by U.S. leadership, has fostered an effective and innovative system that has supercharged U.S. and global economic growth. In an era of rapid technological transformation and global scale, standards will continue to define and drive the markets of the future. Standards for CET—advanced technologies that are significant for U.S. competitiveness and national security - carry strategic significance. The United States will work with all nations committed to an open and transparent standards system to lead the way in these new arenas - just as we did with previous internet, wireless communications, and other digital standards. Failing to do so will risk the United States’—and the world’s—innovation, security, and prosperity. Standards for Critical and Emerging Technology The United States will prioritize efforts for standards development for a subset of CET that are essential for U.S. competitiveness and national security, including the following areas: • Communication and Networking Technologies, which are enabling dramatic changes in how consumers, businesses, and governments interact, and which will form the basis of tomorrow’s critical communications networks; • Semiconductors and Microelectronics, including Computing, Memory, and Storage Technologies, which affect every corner of the global economy, society, and government, and which power a panoply of innovations and capabilities; • Artificial Intelligence and Machine Learning, which promise transformative technologies and scientific breakthroughs across industries, but which must be developed in a trustworthy and risk-managed manner; • Biotechnologies, which will affect the health, agricultural, and industrial sectors of all nations, and which will need to be used safely and securely to support the health of our citizens, animals, and environment; • Positioning, Navigation, and Timing Services, which are a largely invisible utility for technology and infrastructure, including the electrical power grid, communications infrastructure and mobile devices, all modes of transportation, precision agriculture, weather forecasting, and emergency response; • Digital Identity Infrastructure and Distributed Ledger Technologies, which increasingly affect a range of key economic sectors; • Clean Energy Generation and Storage, which are critical to the generation, storage, distribution, and climate-friendly and efficient utilization of energy, and to the security of the technologies that support energy-producing plants; and • Quantum Information Technologies, which leverage quantum mechanics for the storage, transmission, manipulation, computing, or measurement of information, with major national security and economic implications. There are also specific applications of CET that departments and agencies have determined will impact our global economy and national security. The United States will focus standards development activities and outreach on these applications, which include: • Automated and Connected Infrastructure, such as smart communities, Internet of Things, and other novel applications; • Biobanking, which involves the collection, storage, and use of biological samples; • Automated, Connected, and Electrified Transportation, including automated and connected surface vehicles of many types and unmanned aircraft systems, many of which may be electric vehicles (EVs), along with the safe and efficient integration into smart communities and the transportation system as a whole, including standards to integrate EVs with the electrical grid and charging infrastructure; • Critical Minerals Supply Chains, where we will promote standards that support increased sustainable extraction of critical minerals necessary to manufacture renewable energy technologies, semiconductors, and EVs; • Cybersecurity and Privacy, which are cross-cutting issues that are critical to enabling the development and deployment of emerging technologies and promote the free flow of data and ideas with trust; and • Carbon Capture, Removal, Utilization and Storage, which can build on evolving standards for CO2 storage, and emerging standards for point source carbon capture, removal, and utilization, especially as those standards relate to monitoring and verification.
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Write your answer using simple language and do not exceed 120 words. Replace all mention of the word technology with "tech." Please answer using only the information provided below. Do not use any external sources or prior knowledge to support your response.
EVIDENCE:
What Standards Are and Why They Matter From computers and smartphones to cars and lightbulbs, societies rely on technology standards for everyday life. In the broadest sense, standards are the common and repeated use of rules, conditions, guidelines, or characteristics for products or related processes, practices, and production methods. They enable technology that is safe, universal, and interoperable. Standards define the requirements that make it possible for mobile phones sold in different countries to communicate across the world, for bank cards issued in one country to be recognized at ATMs in another, and for cars to run on fuel purchased from any gas station. Standards also help manage risk, security, safety, privacy, and quality in the development of new innovations. In short, good standards are good for business, good for consumers, and good for society. Standards Developing Organizations (SDOs) consist of experts from industry, academia, civil society groups, and government, all of whom share a common goal of ensuring safety, interoperability, and competition in a particular technology or technology application. In well functioning SDOs, ideas are selected not on the basis of the nationality, employer, or personality originating them, but instead on the basis of technical merit. Six principles govern the international standards development process: transparency, openness, impartiality and consensus, effectiveness and relevance, coherence, and a commitment to participation by low- and middle-income countries. The private sector has led U.S. engagement with SDOs for more than 100 years. An example of how this system works comes from the communications industry. Qualcomm Technologies provided the proposal in the 1990s that became the basis for all 3G standards, while NTT Docomo, a large mobile phone operator in Japan, provided the proposal that later became LTE, the predominant standard for wireless broadband communication for mobile devices and data terminals. This private sector leadership has come with significant assistance from government and academia. In 1901, the Congress established the National Bureau of Standards—which has since become the National Institute of Standards and Technology (NIST)—as the authoritative domestic measurement science research and standards laboratory. Not long after, five engineering societies and three Federal agencies banded together to establish a national non governmental body now known as the American National Standards Institute (ANSI). ANSI is a private, nonprofit organization that administers and coordinates the U.S. standardization system and is the sole U.S. representative to the International Organization for Standardization (ISO) and the International Electrotechnical Commission. Industry, consortia, and private-sector groups often complement the roles of NIST, ANSI, and ANSI-accredited SDOs, working together to develop standards to solve specific challenges. To date, this approach, supported by U.S. leadership, has fostered an effective and innovative system that has supercharged U.S. and global economic growth. In an era of rapid technological transformation and global scale, standards will continue to define and drive the markets of the future. Standards for CET—advanced technologies that are significant for U.S. competitiveness and national security - carry strategic significance. The United States will work with all nations committed to an open and transparent standards system to lead the way in these new arenas - just as we did with previous internet, wireless communications, and other digital standards. Failing to do so will risk the United States’—and the world’s—innovation, security, and prosperity. Standards for Critical and Emerging Technology The United States will prioritize efforts for standards development for a subset of CET that are essential for U.S. competitiveness and national security, including the following areas: • Communication and Networking Technologies, which are enabling dramatic changes in how consumers, businesses, and governments interact, and which will form the basis of tomorrow’s critical communications networks; • Semiconductors and Microelectronics, including Computing, Memory, and Storage Technologies, which affect every corner of the global economy, society, and government, and which power a panoply of innovations and capabilities; • Artificial Intelligence and Machine Learning, which promise transformative technologies and scientific breakthroughs across industries, but which must be developed in a trustworthy and risk-managed manner; • Biotechnologies, which will affect the health, agricultural, and industrial sectors of all nations, and which will need to be used safely and securely to support the health of our citizens, animals, and environment; • Positioning, Navigation, and Timing Services, which are a largely invisible utility for technology and infrastructure, including the electrical power grid, communications infrastructure and mobile devices, all modes of transportation, precision agriculture, weather forecasting, and emergency response; • Digital Identity Infrastructure and Distributed Ledger Technologies, which increasingly affect a range of key economic sectors; • Clean Energy Generation and Storage, which are critical to the generation, storage, distribution, and climate-friendly and efficient utilization of energy, and to the security of the technologies that support energy-producing plants; and • Quantum Information Technologies, which leverage quantum mechanics for the storage, transmission, manipulation, computing, or measurement of information, with major national security and economic implications. There are also specific applications of CET that departments and agencies have determined will impact our global economy and national security. The United States will focus standards development activities and outreach on these applications, which include: • Automated and Connected Infrastructure, such as smart communities, Internet of Things, and other novel applications; • Biobanking, which involves the collection, storage, and use of biological samples; • Automated, Connected, and Electrified Transportation, including automated and connected surface vehicles of many types and unmanned aircraft systems, many of which may be electric vehicles (EVs), along with the safe and efficient integration into smart communities and the transportation system as a whole, including standards to integrate EVs with the electrical grid and charging infrastructure; • Critical Minerals Supply Chains, where we will promote standards that support increased sustainable extraction of critical minerals necessary to manufacture renewable energy technologies, semiconductors, and EVs; • Cybersecurity and Privacy, which are cross-cutting issues that are critical to enabling the development and deployment of emerging technologies and promote the free flow of data and ideas with trust; and • Carbon Capture, Removal, Utilization and Storage, which can build on evolving standards for CO2 storage, and emerging standards for point source carbon capture, removal, and utilization, especially as those standards relate to monitoring and verification.
USER:
In well-functioning Standards Developing Organizations, how are ideas selected?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 42 | 9 | 1,015 | null | 160 |
Use only the provided context for your response, without relying on external information.
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Only using the provided text, in which types of solid tumors does BRAF mutations occur?
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**About BRAF Mutations** TESTING FOR BRAF MUTATIONS IN SOLID TUMORS CAN INFORM CRITICAL TREATMENT DECISIONS BRAF V600 has been identified as a driver mutation across various solid tumors BRAF mutations occur in about 8% of solid tumors, most commonly in melanoma and thyroid cancers Indication TAFINLAR, in combination with MEKINIST, is indicated for the treatment of adult and pediatric patients 1 year of age and older with unresectable or metastatic solid tumors with BRAF V600E mutation who have progressed following prior treatment and have no satisfactory alternative treatment options. This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials. Limitation of Use: TAFINLAR, in combination with MEKINIST, is not indicated for the treatment of patients with colorectal cancer because of known intrinsic resistance to BRAF inhibition. TAFINLAR is not indicated for the treatment of patients with wild-type BRAF solid tumors. Important Safety Information New Primary Malignancies Cutaneous Malignancies In the pooled adult safety population of TAFINLAR administered with MEKINIST (“the combination”), the incidence of cutaneous squamous cell carcinoma (cuSCC, including keratoacanthomas) occurred in 2% of patients. Basal cell carcinoma and new primary melanoma occurred in 3% and <1% of patients, respectively. In the pooled pediatric safety population of the combination, new primary melanoma occurred in <1% of patients. Perform dermatologic evaluations prior to initiation of the combination, every 2 months while on therapy, and for up to 6 months following discontinuation. Noncutaneous Malignancies Based on its mechanism of action, TAFINLAR may promote the growth and development of malignancies with activation of monomeric G protein (RAS) through mutation or other mechanisms. In the pooled adult safety population of TAFINLAR monotherapy and the combination, noncutaneous malignancies occurred in 1% of patients. Monitor patients receiving the combination for signs or symptoms of noncutaneous malignancies. Permanently discontinue TAFINLAR for RAS-mutation–positive noncutaneous malignancies. No dose modification is required for MEKINIST in patients who develop noncutaneous malignancies. Tumor Promotion in BRAF Wild-type Tumors. In vitro experiments have demonstrated paradoxical activation of mitogen-activated protein kinase (MAPK) signaling and increased cell proliferation in BRAF wild-type cells that are exposed to BRAF inhibitors. Confirm evidence of BRAF V600E or V600K mutation status prior to initiation of therapy. Hemorrhage. Hemorrhage, including major hemorrhage defined as symptomatic bleeding in a critical area or organ, can occur with the combination. Fatal cases have been reported. In the pooled adult safety population of the combination, hemorrhagic events occurred in 17% of patients; gastrointestinal hemorrhage occurred in 3% of patients; intracranial hemorrhage occurred in 0.6% of patients; fatal hemorrhage occurred in 0.5% of patients. The fatal events were cerebral hemorrhage and brainstem hemorrhage. In the pooled pediatric safety population of the combination, hemorrhagic events occurred in 25% of patients; the most common type of bleeding was epistaxis (16%). Serious events of bleeding occurred in 3.6% of patients and included gastrointestinal hemorrhage (1.2%), cerebral hemorrhage (0.6%), uterine hemorrhage (0.6%), postprocedural hemorrhage (0.6%), and epistaxis (0.6%). Permanently discontinue TAFINLAR for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold TAFINLAR for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Permanently discontinue MEKINIST for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold MEKINIST for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Colitis and Gastrointestinal Perforation. Colitis and gastrointestinal perforation, including fatal outcomes, can occur. In the pooled adult safety population of MEKINIST administered with TAFINLAR, colitis occurred in <1% of patients and gastrointestinal perforation occurred in <1% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, colitis events occurred in <1% of patients. Monitor patients closely for colitis and gastrointestinal perforations. Venous Thromboembolic Events. In the pooled adult safety population of MEKINIST administered with TAFINLAR, deep vein thrombosis (DVT) and pulmonary embolism (PE) occurred in 2% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, embolism events occurred in <1% of patients. Advise patients to immediately seek medical care if they develop symptoms of DVT or PE, such as shortness of breath, chest pain, or arm or leg swelling. Permanently discontinue MEKINIST for life-threatening PE. Withhold MEKINIST for uncomplicated DVT and PE for up to 3 weeks; if improved, MEKINIST may be resumed at a lower dose. Cardiomyopathy. Cardiomyopathy, including cardiac failure, can occur. In the pooled adult safety population of the combination, cardiomyopathy, defined as a decrease in left ventricular ejection fraction (LVEF) ≥10% from baseline and below the institutional lower limit of normal (LLN), occurred in 6% of patients. Development of cardiomyopathy resulted in dose interruption or discontinuation of TAFINLAR in 3% and <1% of patients, respectively, and in 3% and <1% of patients receiving MEKINIST, respectively. Cardiomyopathy resolved in 45 of 50 patients who received the combination. In the pooled pediatric safety population of the combination, cardiomyopathy, defined as a decrease in LVEF ≥10% from baseline and below the institutional LLN, occurred in 9% of patients. Assess LVEF by echocardiogram or multigated acquisition (MUGA) scan before initiation of the combination, 1 month after initiation, and then at 2- to 3-month intervals while on treatment. Withhold TAFINLAR for symptomatic cardiomyopathy or asymptomatic left ventricular dysfunction of >20% from baseline that is below institutional LLN. Resume TAFINLAR at the same dose level upon recovery of cardiac function to at least the institutional LLN for LVEF and absolute decrease ≤10% compared to baseline. For an asymptomatic absolute decrease in LVEF of 10% or greater from baseline that is below the LLN, withhold MEKINIST for up to 4 weeks. If improved to normal LVEF value, resume at a lower dose. If no improvement to normal LVEF value within 4 weeks, permanently discontinue MEKINIST. For symptomatic cardiomyopathy or an absolute decrease in LVEF of >20% from baseline that is below LLN, permanently discontinue MEKINIST. Ocular Toxicities Retinal Vein Occlusion (RVO): There were no cases of RVO across clinical trials of the combination. RVO may lead to macular edema, decreased visual function, neovascularization, and glaucoma. Urgently (within 24 hours) perform ophthalmologic evaluation for patient-reported loss of vision or other visual disturbances. Permanently discontinue MEKINIST in patients with documented RVO. Retinal Pigment Epithelial Detachment (RPED): RPED can occur. Retinal detachments may be bilateral and multifocal, occurring in the central macular region of the retina or elsewhere in the retina. In clinical trials, routine monitoring of patients to detect asymptomatic RPED was not conducted; therefore, the true incidence of this finding is unknown. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, RPED events occurred in <1% of patients. Perform ophthalmologic evaluation periodically, and at any time a patient reports visual disturbances. Withhold MEKINIST if RPED is diagnosed. If resolution of the RPED is documented on repeat ophthalmologic evaluation within 3 weeks, resume MEKINIST at the same or a reduced dose. If no improvement after 3 weeks, resume at a reduced dose or permanently discontinue MEKINIST. Uveitis: In the pooled adult safety population of the combination, uveitis occurred in 2% of patients. In the pooled pediatric safety population of the combination, uveitis occurred in 1.2% of patients. Treatment employed in clinical trials included steroid and mydriatic ophthalmic drops. Monitor patients for visual signs and symptoms of uveitis (eg, change in vision, photophobia, and eye pain). If iritis is diagnosed, administer ocular therapy and continue TAFINLAR without dose modification. If severe uveitis (ie, iridocyclitis) or if mild or moderate uveitis does not respond to ocular therapy, withhold TAFINLAR and treat as clinically indicated. Resume TAFINLAR at the same or lower dose if uveitis improves to grade 0 or 1. Permanently discontinue TAFINLAR for persistent grade 2 or greater uveitis of >6 weeks.
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{Article} ========== **About BRAF Mutations** TESTING FOR BRAF MUTATIONS IN SOLID TUMORS CAN INFORM CRITICAL TREATMENT DECISIONS BRAF V600 has been identified as a driver mutation across various solid tumors BRAF mutations occur in about 8% of solid tumors, most commonly in melanoma and thyroid cancers Indication TAFINLAR, in combination with MEKINIST, is indicated for the treatment of adult and pediatric patients 1 year of age and older with unresectable or metastatic solid tumors with BRAF V600E mutation who have progressed following prior treatment and have no satisfactory alternative treatment options. This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials. Limitation of Use: TAFINLAR, in combination with MEKINIST, is not indicated for the treatment of patients with colorectal cancer because of known intrinsic resistance to BRAF inhibition. TAFINLAR is not indicated for the treatment of patients with wild-type BRAF solid tumors. Important Safety Information New Primary Malignancies Cutaneous Malignancies In the pooled adult safety population of TAFINLAR administered with MEKINIST (“the combination”), the incidence of cutaneous squamous cell carcinoma (cuSCC, including keratoacanthomas) occurred in 2% of patients. Basal cell carcinoma and new primary melanoma occurred in 3% and <1% of patients, respectively. In the pooled pediatric safety population of the combination, new primary melanoma occurred in <1% of patients. Perform dermatologic evaluations prior to initiation of the combination, every 2 months while on therapy, and for up to 6 months following discontinuation. Noncutaneous Malignancies Based on its mechanism of action, TAFINLAR may promote the growth and development of malignancies with activation of monomeric G protein (RAS) through mutation or other mechanisms. In the pooled adult safety population of TAFINLAR monotherapy and the combination, noncutaneous malignancies occurred in 1% of patients. Monitor patients receiving the combination for signs or symptoms of noncutaneous malignancies. Permanently discontinue TAFINLAR for RAS-mutation–positive noncutaneous malignancies. No dose modification is required for MEKINIST in patients who develop noncutaneous malignancies. Tumor Promotion in BRAF Wild-type Tumors. In vitro experiments have demonstrated paradoxical activation of mitogen-activated protein kinase (MAPK) signaling and increased cell proliferation in BRAF wild-type cells that are exposed to BRAF inhibitors. Confirm evidence of BRAF V600E or V600K mutation status prior to initiation of therapy. Hemorrhage. Hemorrhage, including major hemorrhage defined as symptomatic bleeding in a critical area or organ, can occur with the combination. Fatal cases have been reported. In the pooled adult safety population of the combination, hemorrhagic events occurred in 17% of patients; gastrointestinal hemorrhage occurred in 3% of patients; intracranial hemorrhage occurred in 0.6% of patients; fatal hemorrhage occurred in 0.5% of patients. The fatal events were cerebral hemorrhage and brainstem hemorrhage. In the pooled pediatric safety population of the combination, hemorrhagic events occurred in 25% of patients; the most common type of bleeding was epistaxis (16%). Serious events of bleeding occurred in 3.6% of patients and included gastrointestinal hemorrhage (1.2%), cerebral hemorrhage (0.6%), uterine hemorrhage (0.6%), postprocedural hemorrhage (0.6%), and epistaxis (0.6%). Permanently discontinue TAFINLAR for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold TAFINLAR for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Permanently discontinue MEKINIST for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold MEKINIST for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Colitis and Gastrointestinal Perforation. Colitis and gastrointestinal perforation, including fatal outcomes, can occur. In the pooled adult safety population of MEKINIST administered with TAFINLAR, colitis occurred in <1% of patients and gastrointestinal perforation occurred in <1% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, colitis events occurred in <1% of patients. Monitor patients closely for colitis and gastrointestinal perforations. Venous Thromboembolic Events. In the pooled adult safety population of MEKINIST administered with TAFINLAR, deep vein thrombosis (DVT) and pulmonary embolism (PE) occurred in 2% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, embolism events occurred in <1% of patients. Advise patients to immediately seek medical care if they develop symptoms of DVT or PE, such as shortness of breath, chest pain, or arm or leg swelling. Permanently discontinue MEKINIST for life-threatening PE. Withhold MEKINIST for uncomplicated DVT and PE for up to 3 weeks; if improved, MEKINIST may be resumed at a lower dose. Cardiomyopathy. Cardiomyopathy, including cardiac failure, can occur. In the pooled adult safety population of the combination, cardiomyopathy, defined as a decrease in left ventricular ejection fraction (LVEF) ≥10% from baseline and below the institutional lower limit of normal (LLN), occurred in 6% of patients. Development of cardiomyopathy resulted in dose interruption or discontinuation of TAFINLAR in 3% and <1% of patients, respectively, and in 3% and <1% of patients receiving MEKINIST, respectively. Cardiomyopathy resolved in 45 of 50 patients who received the combination. In the pooled pediatric safety population of the combination, cardiomyopathy, defined as a decrease in LVEF ≥10% from baseline and below the institutional LLN, occurred in 9% of patients. Assess LVEF by echocardiogram or multigated acquisition (MUGA) scan before initiation of the combination, 1 month after initiation, and then at 2- to 3-month intervals while on treatment. Withhold TAFINLAR for symptomatic cardiomyopathy or asymptomatic left ventricular dysfunction of >20% from baseline that is below institutional LLN. Resume TAFINLAR at the same dose level upon recovery of cardiac function to at least the institutional LLN for LVEF and absolute decrease ≤10% compared to baseline. For an asymptomatic absolute decrease in LVEF of 10% or greater from baseline that is below the LLN, withhold MEKINIST for up to 4 weeks. If improved to normal LVEF value, resume at a lower dose. If no improvement to normal LVEF value within 4 weeks, permanently discontinue MEKINIST. For symptomatic cardiomyopathy or an absolute decrease in LVEF of >20% from baseline that is below LLN, permanently discontinue MEKINIST. Ocular Toxicities Retinal Vein Occlusion (RVO): There were no cases of RVO across clinical trials of the combination. RVO may lead to macular edema, decreased visual function, neovascularization, and glaucoma. Urgently (within 24 hours) perform ophthalmologic evaluation for patient-reported loss of vision or other visual disturbances. Permanently discontinue MEKINIST in patients with documented RVO. Retinal Pigment Epithelial Detachment (RPED): RPED can occur. Retinal detachments may be bilateral and multifocal, occurring in the central macular region of the retina or elsewhere in the retina. In clinical trials, routine monitoring of patients to detect asymptomatic RPED was not conducted; therefore, the true incidence of this finding is unknown. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, RPED events occurred in <1% of patients. Perform ophthalmologic evaluation periodically, and at any time a patient reports visual disturbances. Withhold MEKINIST if RPED is diagnosed. If resolution of the RPED is documented on repeat ophthalmologic evaluation within 3 weeks, resume MEKINIST at the same or a reduced dose. If no improvement after 3 weeks, resume at a reduced dose or permanently discontinue MEKINIST. Uveitis: In the pooled adult safety population of the combination, uveitis occurred in 2% of patients. In the pooled pediatric safety population of the combination, uveitis occurred in 1.2% of patients. Treatment employed in clinical trials included steroid and mydriatic ophthalmic drops. Monitor patients for visual signs and symptoms of uveitis (eg, change in vision, photophobia, and eye pain). If iritis is diagnosed, administer ocular therapy and continue TAFINLAR without dose modification. If severe uveitis (ie, iridocyclitis) or if mild or moderate uveitis does not respond to ocular therapy, withhold TAFINLAR and treat as clinically indicated. Resume TAFINLAR at the same or lower dose if uveitis improves to grade 0 or 1. Permanently discontinue TAFINLAR for persistent grade 2 or greater uveitis of >6 weeks. ---------- {Instruction} ========== Use only the provided context for your response, without relying on external information. ---------- {Question} ========== Only using the provided text, in which types of solid tumors does BRAF mutations occur?
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Use only the provided context for your response, without relying on external information.
EVIDENCE:
**About BRAF Mutations** TESTING FOR BRAF MUTATIONS IN SOLID TUMORS CAN INFORM CRITICAL TREATMENT DECISIONS BRAF V600 has been identified as a driver mutation across various solid tumors BRAF mutations occur in about 8% of solid tumors, most commonly in melanoma and thyroid cancers Indication TAFINLAR, in combination with MEKINIST, is indicated for the treatment of adult and pediatric patients 1 year of age and older with unresectable or metastatic solid tumors with BRAF V600E mutation who have progressed following prior treatment and have no satisfactory alternative treatment options. This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials. Limitation of Use: TAFINLAR, in combination with MEKINIST, is not indicated for the treatment of patients with colorectal cancer because of known intrinsic resistance to BRAF inhibition. TAFINLAR is not indicated for the treatment of patients with wild-type BRAF solid tumors. Important Safety Information New Primary Malignancies Cutaneous Malignancies In the pooled adult safety population of TAFINLAR administered with MEKINIST (“the combination”), the incidence of cutaneous squamous cell carcinoma (cuSCC, including keratoacanthomas) occurred in 2% of patients. Basal cell carcinoma and new primary melanoma occurred in 3% and <1% of patients, respectively. In the pooled pediatric safety population of the combination, new primary melanoma occurred in <1% of patients. Perform dermatologic evaluations prior to initiation of the combination, every 2 months while on therapy, and for up to 6 months following discontinuation. Noncutaneous Malignancies Based on its mechanism of action, TAFINLAR may promote the growth and development of malignancies with activation of monomeric G protein (RAS) through mutation or other mechanisms. In the pooled adult safety population of TAFINLAR monotherapy and the combination, noncutaneous malignancies occurred in 1% of patients. Monitor patients receiving the combination for signs or symptoms of noncutaneous malignancies. Permanently discontinue TAFINLAR for RAS-mutation–positive noncutaneous malignancies. No dose modification is required for MEKINIST in patients who develop noncutaneous malignancies. Tumor Promotion in BRAF Wild-type Tumors. In vitro experiments have demonstrated paradoxical activation of mitogen-activated protein kinase (MAPK) signaling and increased cell proliferation in BRAF wild-type cells that are exposed to BRAF inhibitors. Confirm evidence of BRAF V600E or V600K mutation status prior to initiation of therapy. Hemorrhage. Hemorrhage, including major hemorrhage defined as symptomatic bleeding in a critical area or organ, can occur with the combination. Fatal cases have been reported. In the pooled adult safety population of the combination, hemorrhagic events occurred in 17% of patients; gastrointestinal hemorrhage occurred in 3% of patients; intracranial hemorrhage occurred in 0.6% of patients; fatal hemorrhage occurred in 0.5% of patients. The fatal events were cerebral hemorrhage and brainstem hemorrhage. In the pooled pediatric safety population of the combination, hemorrhagic events occurred in 25% of patients; the most common type of bleeding was epistaxis (16%). Serious events of bleeding occurred in 3.6% of patients and included gastrointestinal hemorrhage (1.2%), cerebral hemorrhage (0.6%), uterine hemorrhage (0.6%), postprocedural hemorrhage (0.6%), and epistaxis (0.6%). Permanently discontinue TAFINLAR for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold TAFINLAR for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Permanently discontinue MEKINIST for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold MEKINIST for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Colitis and Gastrointestinal Perforation. Colitis and gastrointestinal perforation, including fatal outcomes, can occur. In the pooled adult safety population of MEKINIST administered with TAFINLAR, colitis occurred in <1% of patients and gastrointestinal perforation occurred in <1% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, colitis events occurred in <1% of patients. Monitor patients closely for colitis and gastrointestinal perforations. Venous Thromboembolic Events. In the pooled adult safety population of MEKINIST administered with TAFINLAR, deep vein thrombosis (DVT) and pulmonary embolism (PE) occurred in 2% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, embolism events occurred in <1% of patients. Advise patients to immediately seek medical care if they develop symptoms of DVT or PE, such as shortness of breath, chest pain, or arm or leg swelling. Permanently discontinue MEKINIST for life-threatening PE. Withhold MEKINIST for uncomplicated DVT and PE for up to 3 weeks; if improved, MEKINIST may be resumed at a lower dose. Cardiomyopathy. Cardiomyopathy, including cardiac failure, can occur. In the pooled adult safety population of the combination, cardiomyopathy, defined as a decrease in left ventricular ejection fraction (LVEF) ≥10% from baseline and below the institutional lower limit of normal (LLN), occurred in 6% of patients. Development of cardiomyopathy resulted in dose interruption or discontinuation of TAFINLAR in 3% and <1% of patients, respectively, and in 3% and <1% of patients receiving MEKINIST, respectively. Cardiomyopathy resolved in 45 of 50 patients who received the combination. In the pooled pediatric safety population of the combination, cardiomyopathy, defined as a decrease in LVEF ≥10% from baseline and below the institutional LLN, occurred in 9% of patients. Assess LVEF by echocardiogram or multigated acquisition (MUGA) scan before initiation of the combination, 1 month after initiation, and then at 2- to 3-month intervals while on treatment. Withhold TAFINLAR for symptomatic cardiomyopathy or asymptomatic left ventricular dysfunction of >20% from baseline that is below institutional LLN. Resume TAFINLAR at the same dose level upon recovery of cardiac function to at least the institutional LLN for LVEF and absolute decrease ≤10% compared to baseline. For an asymptomatic absolute decrease in LVEF of 10% or greater from baseline that is below the LLN, withhold MEKINIST for up to 4 weeks. If improved to normal LVEF value, resume at a lower dose. If no improvement to normal LVEF value within 4 weeks, permanently discontinue MEKINIST. For symptomatic cardiomyopathy or an absolute decrease in LVEF of >20% from baseline that is below LLN, permanently discontinue MEKINIST. Ocular Toxicities Retinal Vein Occlusion (RVO): There were no cases of RVO across clinical trials of the combination. RVO may lead to macular edema, decreased visual function, neovascularization, and glaucoma. Urgently (within 24 hours) perform ophthalmologic evaluation for patient-reported loss of vision or other visual disturbances. Permanently discontinue MEKINIST in patients with documented RVO. Retinal Pigment Epithelial Detachment (RPED): RPED can occur. Retinal detachments may be bilateral and multifocal, occurring in the central macular region of the retina or elsewhere in the retina. In clinical trials, routine monitoring of patients to detect asymptomatic RPED was not conducted; therefore, the true incidence of this finding is unknown. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, RPED events occurred in <1% of patients. Perform ophthalmologic evaluation periodically, and at any time a patient reports visual disturbances. Withhold MEKINIST if RPED is diagnosed. If resolution of the RPED is documented on repeat ophthalmologic evaluation within 3 weeks, resume MEKINIST at the same or a reduced dose. If no improvement after 3 weeks, resume at a reduced dose or permanently discontinue MEKINIST. Uveitis: In the pooled adult safety population of the combination, uveitis occurred in 2% of patients. In the pooled pediatric safety population of the combination, uveitis occurred in 1.2% of patients. Treatment employed in clinical trials included steroid and mydriatic ophthalmic drops. Monitor patients for visual signs and symptoms of uveitis (eg, change in vision, photophobia, and eye pain). If iritis is diagnosed, administer ocular therapy and continue TAFINLAR without dose modification. If severe uveitis (ie, iridocyclitis) or if mild or moderate uveitis does not respond to ocular therapy, withhold TAFINLAR and treat as clinically indicated. Resume TAFINLAR at the same or lower dose if uveitis improves to grade 0 or 1. Permanently discontinue TAFINLAR for persistent grade 2 or greater uveitis of >6 weeks.
USER:
Only using the provided text, in which types of solid tumors does BRAF mutations occur?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 13 | 15 | 1,301 | null | 74 |
For this task, you must only answer using the context block provided. Prior knowledge and external resources are disallowed.
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Summarise the court findings of the Silkroad case
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Silk Road In 2013, federal authorities shut down Silk Road, which they alleged was “the most sophisticated and extensive criminal marketplace on the Internet,” enabling tens of thousands of users to anonymously buy and sell illegal drugs, malicious software, and other illicit goods and services. 38 Federal prosecutors charged the site’s creator with, among other things, conspiracy to commit money laundering under Section 1956. 39 The prosecutors alleged that the site’s creator conspired to conduct “financial transactions” involving the proceeds of unlawful activity—namely, narcotics trafficking and computer hacking—with the intent to promote the carrying on of such activity.40 In defending this charge, Silk Road’s creator argued that his alleged conduct— facilitating the exchange of Bitcoin for illegal goods and services—did not involve “financial transactions” within the meaning of Section 1956, which defines that term to include (among other things) transactions “involving one or more monetary instruments.” 41 Specifically, the site’s creator contended that because Bitcoin does not qualify as a “monetary instrument”—which Section 1956 defines to mean the currency of a country, personal checks, bank checks, money orders, investment securities, or negotiable instruments—transactions involving Bitcoin do not represent “financial transactions” under Section 1956.42 The U.S. District Court for the Southern District of New York rejected this argument, holding that transactions involving Bitcoin can qualify as “financial transactions” under Section 1956 because they fall under a separate category of transactions identified by the relevant statutory definition: transactions involving “the movement of funds.”43 Specifically, the court reasoned that Bitcoin transactions involve “the movement of funds” because the term “funds” includes “money,” which in turn refers to “an object used to buy things.” 44 Because Bitcoin can be used to buy things, the court reasoned that Bitcoin transactions involve “the movement of funds” and therefore qualify as “financial transactions” under Section 1956.45 As a result, the court explained, “[o]ne can money launder using Bitcoin.” 46 AlphaBay Similarly, in 2017, federal prosecutors brought money-laundering conspiracy charges against the creator of AlphaBay, another online marketplace that allowed its users to exchange virtual currency for illicit goods and services.47 The prosecutors alleged that by facilitating the exchange of virtual currencies (including Bitcoin, Monero, and Ether) for illegal narcotics and other illicit goods and services, the site’s creator had conspired to conduct “financial transactions” involving the proceeds of unlawful activities. 48 However, the federal government dismissed these charges after AlphaBay’s creator died in July 2017.49 Virtual Currency Payment Systems Used for Illicit Purposes Federal prosecutors have also pursued charges against the developers of certain virtual currency payment systems allegedly designed to facilitate illicit transactions and launder the proceeds of criminal activity.50 Specifically, prosecutors have charged these developers with conspiring to commit money laundering and operating unlicensed money transmitting businesses under Sections 1956 and 1960, respectively. In adjudicating the second category of charges, courts have concluded that the relevant virtual currency payment systems were “unlicensed money transmitting businesses” under Section 1960, rejecting the argument that the provision applies only to money transmitters that facilitate cash transactions. e-Gold In 2007, federal prosecutors charged e-Gold—an “alternative payment system” and virtual currency purportedly backed by stored physical gold—and its founders and director with money laundering and operating an unlicensed money transmitting business.51 The prosecutors alleged that e-Gold “was widely accepted as a payment mechanism for transactions involving credit card and identification fraud, high yield investment programs and other investment scams, and child exploitation” because of the anonymity it offered its users.52 In charging the defendants for failing to register their business, prosecutors alleged that e-Gold operated as an “unlicensed money transmitting business” in each of the three ways identified by Section 1960—the provision criminalizing the operation of “unlicensed money transmitting businesses.” Specifically, the prosecutors alleged that e-Gold (1) lacked a required state money transmitter license, (2) failed to comply with the BSA’s federal registration requirements for “money transmitting businesses” (requirements set forth in Section 5330 of Title 31), and (3) was involved in the transmission of funds that were “known to have been derived from a criminal offense” or that were “intended to be used to promote and support unlawful activity.” 53 In defending these charges, the defendants presented an intricate argument for the proposition that Section 1960 applies only to businesses that facilitate cash (as opposed to virtual currency) transactions. Specifically, the defendants argued that because Section 1960 does not define the term “money transmitting business,” it must “borrow” the definition of that term in Section 5330—the BSA provision establishing federal registration requirements for “money transmitting businesses.” 54 The defendants further reasoned that (1) Section 5330 provides that an entity is a “money transmitting business” only if it must file currency transaction reports (CTRs), and (2) businesses that do not facilitate cash transactions need not file CTRs.55 Accordingly, under the defendants’ theory, a business like e-Gold that does not facilitate cash transactions does not qualify as a “money transmitting business” under Section 5330 and (by extension) Section 1960. 56 The U.S. District Court for the District of Columbia rejected this argument, holding that e-Gold was indeed a “money transmitting business” under Section 1960 for two reasons. First, the court rejected the defendants’ contention that Section 1960 must “borrow” Section 5330’s definition of “money transmitting business.” 57 The court rejected this argument on the grounds that Section 1960 contains its own definition of the term “money transmitting” and does not reflect an intent to “borrow” the definition of “money transmitting business” from Section 5330.58 The court further explained that because e-Gold was a business engaged in “money transmitting” as defined by Section 1960—that is, “transferring funds on behalf of the public”—it was a “money transmitting business” under Section 1960.59 Second, the court evaluated whether e-Gold also qualified as a “money transmitting business” under Section 5330—an issue that remained relevant because of the federal government’s charge that the defendants violated Section 1960 by violating Section 5330’s registration requirements. The court concluded that e-Gold was indeed a “money transmitting business” under Section 5330, rejecting the defendants’ argument that e-Gold did not fall within that category because it was not required to file CTRs.60 Specifically, the court rejected the argument that a business is required to file CTRs only if it facilitates cash transactions. Instead, the court explained that because the statute imposing CTR obligations imposes such obligations when money transmitting businesses facilitate cash transactions (as opposed to if they facilitate such transactions), all money transmitting businesses have a continuing obligation to file CTRs “in the eventuality that they ever are involved” in a reportable cash transaction.61 The court accordingly concluded that because e-Gold was required to file CTRs and satisfied the other elements of the relevant statutory definition, e-Gold was a “money transmitting business” under Section 5330 even though it did not process cash transactions.62 After the court denied the defendants’ motion to dismiss the charges for operating an unlicensed money transmitting business, the defendants pleaded guilty to those charges and money laundering.
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Summarise the court findings of the Silkroad case Silk Road In 2013, federal authorities shut down Silk Road, which they alleged was “the most sophisticated and extensive criminal marketplace on the Internet,” enabling tens of thousands of users to anonymously buy and sell illegal drugs, malicious software, and other illicit goods and services. 38 Federal prosecutors charged the site’s creator with, among other things, conspiracy to commit money laundering under Section 1956. 39 The prosecutors alleged that the site’s creator conspired to conduct “financial transactions” involving the proceeds of unlawful activity—namely, narcotics trafficking and computer hacking—with the intent to promote the carrying on of such activity.40 In defending this charge, Silk Road’s creator argued that his alleged conduct— facilitating the exchange of Bitcoin for illegal goods and services—did not involve “financial transactions” within the meaning of Section 1956, which defines that term to include (among other things) transactions “involving one or more monetary instruments.” 41 Specifically, the site’s creator contended that because Bitcoin does not qualify as a “monetary instrument”—which Section 1956 defines to mean the currency of a country, personal checks, bank checks, money orders, investment securities, or negotiable instruments—transactions involving Bitcoin do not represent “financial transactions” under Section 1956.42 The U.S. District Court for the Southern District of New York rejected this argument, holding that transactions involving Bitcoin can qualify as “financial transactions” under Section 1956 because they fall under a separate category of transactions identified by the relevant statutory definition: transactions involving “the movement of funds.”43 Specifically, the court reasoned that Bitcoin transactions involve “the movement of funds” because the term “funds” includes “money,” which in turn refers to “an object used to buy things.” 44 Because Bitcoin can be used to buy things, the court reasoned that Bitcoin transactions involve “the movement of funds” and therefore qualify as “financial transactions” under Section 1956.45 As a result, the court explained, “[o]ne can money launder using Bitcoin.” 46 AlphaBay Similarly, in 2017, federal prosecutors brought money-laundering conspiracy charges against the creator of AlphaBay, another online marketplace that allowed its users to exchange virtual currency for illicit goods and services.47 The prosecutors alleged that by facilitating the exchange of virtual currencies (including Bitcoin, Monero, and Ether) for illegal narcotics and other illicit goods and services, the site’s creator had conspired to conduct “financial transactions” involving the proceeds of unlawful activities. 48 However, the federal government dismissed these charges after AlphaBay’s creator died in July 2017.49 Virtual Currency Payment Systems Used for Illicit Purposes Federal prosecutors have also pursued charges against the developers of certain virtual currency payment systems allegedly designed to facilitate illicit transactions and launder the proceeds of criminal activity.50 Specifically, prosecutors have charged these developers with conspiring to commit money laundering and operating unlicensed money transmitting businesses under Sections 1956 and 1960, respectively. In adjudicating the second category of charges, courts have concluded that the relevant virtual currency payment systems were “unlicensed money transmitting businesses” under Section 1960, rejecting the argument that the provision applies only to money transmitters that facilitate cash transactions. e-Gold In 2007, federal prosecutors charged e-Gold—an “alternative payment system” and virtual currency purportedly backed by stored physical gold—and its founders and director with money laundering and operating an unlicensed money transmitting business.51 The prosecutors alleged that e-Gold “was widely accepted as a payment mechanism for transactions involving credit card and identification fraud, high yield investment programs and other investment scams, and child exploitation” because of the anonymity it offered its users.52 In charging the defendants for failing to register their business, prosecutors alleged that e-Gold operated as an “unlicensed money transmitting business” in each of the three ways identified by Section 1960—the provision criminalizing the operation of “unlicensed money transmitting businesses.” Specifically, the prosecutors alleged that e-Gold (1) lacked a required state money transmitter license, (2) failed to comply with the BSA’s federal registration requirements for “money transmitting businesses” (requirements set forth in Section 5330 of Title 31), and (3) was involved in the transmission of funds that were “known to have been derived from a criminal offense” or that were “intended to be used to promote and support unlawful activity.” 53 In defending these charges, the defendants presented an intricate argument for the proposition that Section 1960 applies only to businesses that facilitate cash (as opposed to virtual currency) transactions. Specifically, the defendants argued that because Section 1960 does not define the term “money transmitting business,” it must “borrow” the definition of that term in Section 5330—the BSA provision establishing federal registration requirements for “money transmitting businesses.” 54 The defendants further reasoned that (1) Section 5330 provides that an entity is a “money transmitting business” only if it must file currency transaction reports (CTRs), and (2) businesses that do not facilitate cash transactions need not file CTRs.55 Accordingly, under the defendants’ theory, a business like e-Gold that does not facilitate cash transactions does not qualify as a “money transmitting business” under Section 5330 and (by extension) Section 1960. 56 The U.S. District Court for the District of Columbia rejected this argument, holding that e-Gold was indeed a “money transmitting business” under Section 1960 for two reasons. First, the court rejected the defendants’ contention that Section 1960 must “borrow” Section 5330’s definition of “money transmitting business.” 57 The court rejected this argument on the grounds that Section 1960 contains its own definition of the term “money transmitting” and does not reflect an intent to “borrow” the definition of “money transmitting business” from Section 5330.58 The court further explained that because e-Gold was a business engaged in “money transmitting” as defined by Section 1960—that is, “transferring funds on behalf of the public”—it was a “money transmitting business” under Section 1960.59 Second, the court evaluated whether e-Gold also qualified as a “money transmitting business” under Section 5330—an issue that remained relevant because of the federal government’s charge that the defendants violated Section 1960 by violating Section 5330’s registration requirements. The court concluded that e-Gold was indeed a “money transmitting business” under Section 5330, rejecting the defendants’ argument that e-Gold did not fall within that category because it was not required to file CTRs.60 Specifically, the court rejected the argument that a business is required to file CTRs only if it facilitates cash transactions. Instead, the court explained that because the statute imposing CTR obligations imposes such obligations when money transmitting businesses facilitate cash transactions (as opposed to if they facilitate such transactions), all money transmitting businesses have a continuing obligation to file CTRs “in the eventuality that they ever are involved” in a reportable cash transaction.61 The court accordingly concluded that because e-Gold was required to file CTRs and satisfied the other elements of the relevant statutory definition, e-Gold was a “money transmitting business” under Section 5330 even though it did not process cash transactions.62 After the court denied the defendants’ motion to dismiss the charges for operating an unlicensed money transmitting business, the defendants pleaded guilty to those charges and money laundering. For this task, you must only answer using the context block provided. Prior knowledge and external resources are disallowed.
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For this task, you must only answer using the context block provided. Prior knowledge and external resources are disallowed.
EVIDENCE:
Silk Road In 2013, federal authorities shut down Silk Road, which they alleged was “the most sophisticated and extensive criminal marketplace on the Internet,” enabling tens of thousands of users to anonymously buy and sell illegal drugs, malicious software, and other illicit goods and services. 38 Federal prosecutors charged the site’s creator with, among other things, conspiracy to commit money laundering under Section 1956. 39 The prosecutors alleged that the site’s creator conspired to conduct “financial transactions” involving the proceeds of unlawful activity—namely, narcotics trafficking and computer hacking—with the intent to promote the carrying on of such activity.40 In defending this charge, Silk Road’s creator argued that his alleged conduct— facilitating the exchange of Bitcoin for illegal goods and services—did not involve “financial transactions” within the meaning of Section 1956, which defines that term to include (among other things) transactions “involving one or more monetary instruments.” 41 Specifically, the site’s creator contended that because Bitcoin does not qualify as a “monetary instrument”—which Section 1956 defines to mean the currency of a country, personal checks, bank checks, money orders, investment securities, or negotiable instruments—transactions involving Bitcoin do not represent “financial transactions” under Section 1956.42 The U.S. District Court for the Southern District of New York rejected this argument, holding that transactions involving Bitcoin can qualify as “financial transactions” under Section 1956 because they fall under a separate category of transactions identified by the relevant statutory definition: transactions involving “the movement of funds.”43 Specifically, the court reasoned that Bitcoin transactions involve “the movement of funds” because the term “funds” includes “money,” which in turn refers to “an object used to buy things.” 44 Because Bitcoin can be used to buy things, the court reasoned that Bitcoin transactions involve “the movement of funds” and therefore qualify as “financial transactions” under Section 1956.45 As a result, the court explained, “[o]ne can money launder using Bitcoin.” 46 AlphaBay Similarly, in 2017, federal prosecutors brought money-laundering conspiracy charges against the creator of AlphaBay, another online marketplace that allowed its users to exchange virtual currency for illicit goods and services.47 The prosecutors alleged that by facilitating the exchange of virtual currencies (including Bitcoin, Monero, and Ether) for illegal narcotics and other illicit goods and services, the site’s creator had conspired to conduct “financial transactions” involving the proceeds of unlawful activities. 48 However, the federal government dismissed these charges after AlphaBay’s creator died in July 2017.49 Virtual Currency Payment Systems Used for Illicit Purposes Federal prosecutors have also pursued charges against the developers of certain virtual currency payment systems allegedly designed to facilitate illicit transactions and launder the proceeds of criminal activity.50 Specifically, prosecutors have charged these developers with conspiring to commit money laundering and operating unlicensed money transmitting businesses under Sections 1956 and 1960, respectively. In adjudicating the second category of charges, courts have concluded that the relevant virtual currency payment systems were “unlicensed money transmitting businesses” under Section 1960, rejecting the argument that the provision applies only to money transmitters that facilitate cash transactions. e-Gold In 2007, federal prosecutors charged e-Gold—an “alternative payment system” and virtual currency purportedly backed by stored physical gold—and its founders and director with money laundering and operating an unlicensed money transmitting business.51 The prosecutors alleged that e-Gold “was widely accepted as a payment mechanism for transactions involving credit card and identification fraud, high yield investment programs and other investment scams, and child exploitation” because of the anonymity it offered its users.52 In charging the defendants for failing to register their business, prosecutors alleged that e-Gold operated as an “unlicensed money transmitting business” in each of the three ways identified by Section 1960—the provision criminalizing the operation of “unlicensed money transmitting businesses.” Specifically, the prosecutors alleged that e-Gold (1) lacked a required state money transmitter license, (2) failed to comply with the BSA’s federal registration requirements for “money transmitting businesses” (requirements set forth in Section 5330 of Title 31), and (3) was involved in the transmission of funds that were “known to have been derived from a criminal offense” or that were “intended to be used to promote and support unlawful activity.” 53 In defending these charges, the defendants presented an intricate argument for the proposition that Section 1960 applies only to businesses that facilitate cash (as opposed to virtual currency) transactions. Specifically, the defendants argued that because Section 1960 does not define the term “money transmitting business,” it must “borrow” the definition of that term in Section 5330—the BSA provision establishing federal registration requirements for “money transmitting businesses.” 54 The defendants further reasoned that (1) Section 5330 provides that an entity is a “money transmitting business” only if it must file currency transaction reports (CTRs), and (2) businesses that do not facilitate cash transactions need not file CTRs.55 Accordingly, under the defendants’ theory, a business like e-Gold that does not facilitate cash transactions does not qualify as a “money transmitting business” under Section 5330 and (by extension) Section 1960. 56 The U.S. District Court for the District of Columbia rejected this argument, holding that e-Gold was indeed a “money transmitting business” under Section 1960 for two reasons. First, the court rejected the defendants’ contention that Section 1960 must “borrow” Section 5330’s definition of “money transmitting business.” 57 The court rejected this argument on the grounds that Section 1960 contains its own definition of the term “money transmitting” and does not reflect an intent to “borrow” the definition of “money transmitting business” from Section 5330.58 The court further explained that because e-Gold was a business engaged in “money transmitting” as defined by Section 1960—that is, “transferring funds on behalf of the public”—it was a “money transmitting business” under Section 1960.59 Second, the court evaluated whether e-Gold also qualified as a “money transmitting business” under Section 5330—an issue that remained relevant because of the federal government’s charge that the defendants violated Section 1960 by violating Section 5330’s registration requirements. The court concluded that e-Gold was indeed a “money transmitting business” under Section 5330, rejecting the defendants’ argument that e-Gold did not fall within that category because it was not required to file CTRs.60 Specifically, the court rejected the argument that a business is required to file CTRs only if it facilitates cash transactions. Instead, the court explained that because the statute imposing CTR obligations imposes such obligations when money transmitting businesses facilitate cash transactions (as opposed to if they facilitate such transactions), all money transmitting businesses have a continuing obligation to file CTRs “in the eventuality that they ever are involved” in a reportable cash transaction.61 The court accordingly concluded that because e-Gold was required to file CTRs and satisfied the other elements of the relevant statutory definition, e-Gold was a “money transmitting business” under Section 5330 even though it did not process cash transactions.62 After the court denied the defendants’ motion to dismiss the charges for operating an unlicensed money transmitting business, the defendants pleaded guilty to those charges and money laundering.
USER:
Summarise the court findings of the Silkroad case
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 19 | 8 | 1,150 | null | 858 |
Your responses are always thorough covering all bases to ensure the user has all the information they need, but you find a happy medium to not be to wordy. You always explain how you came to each conclusion and you only use the text that is provided to you to answer questions.
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What acronyms are mentioned?
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AI technologies, including GenAI tools, have many potential benefits, such as accelerating and providing insights into data processing, augmenting human decisionmaking, and optimizing performance for complex systems and tasks. GenAI tools, for example, are increasingly capable of performing a broad range of tasks, such as text analysis, image generation, and speech recognition. However, AI systems may perpetuate or amplify biases in the datasets on which they are trained; may not yet be able to fully explain their decisionmaking; and often depend on such vast amounts of data and other resources that they are not widely accessible for research, development, and commercialization beyond a handful of technology companies. Numerous federal laws on AI have been enacted over the past few Congresses, either as standalone legislation or as AIfocused provisions in broader acts. These include the expansive National Artificial Intelligence Initiative Act of 2020 (Division E of P.L. 116-283), which included the establishment of an American AI Initiative and direction for AI research, development, and evaluation activities at federal science agencies. Additional acts have directed certain agencies to undertake activities to guide AI programs and policies across the federal government (e.g., the AI in Government Act of 2020, P.L. 116- 260; and the Advancing American AI Act, Subtitle B of P.L. 117-263). In the 117th Congress, at least 75 bills were introduced that either focused on AI and ML or had AI/ML-focused provisions. Six of those were enacted. In the 118th Congress, as of June 2023, at least 40 bills had been introduced that either focused on AI/ML or contained AI/ML-focused provisions, and none has been enacted. Collectively, bills in the 118th Congress address a range of topics, including federal government oversight of AI; training for federal employees; disclosure of AI use; export controls; usespecific prohibitions; and support for the use of AI in particular sectors, such as cybersecurity, weather modeling, wildfire detection, precision agriculture, and airport safety. AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. 17 Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in healthcare, as well as the importance of regulations.” 18 A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now.19 And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.”20 This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Federal laws addressing AI or including AI-focused provisions have been enacted over the past few Congresses. Arguably the most expansive law was the National Artificial Intelligence Initiative (NAII) Act of 2020 (Division E of the William M. (Mac) Thornberry National Defense Authorization Act [NDAA] of FY2021, P.L. 116-283). The NAII Act included sections • codifying the establishment of an American AI Initiative, • establishing a National Artificial Intelligence Initiative Office to support federal AI activities, • establishing an interagency committee at the Office of Science and Technology Policy to coordinate federal programs and activities in support of the NAII, and • establishing a National AI Advisory Committee. The NAII Act further directed AI activities at the National Science Foundation (NSF), National Institute of Standards and Technology (NIST),40 National Oceanic and Atmospheric Administration, and Department of Energy. Specific provisions include mandating (1) NSF support for a network of National AI Research Institutes; (2) a National Academies of Sciences, Engineering, and Medicine study on the current and future impact of AI on the U.S. workforce across sectors;41 and (3) a task force to investigate the feasibility of, and plan for, a National AI Research Resource.42 Individual agencies—including the General Services Administration (GSA), the Office of Management and Budget (OMB), and the Office of Personnel Management (OPM)—have also been statutorily directed to undertake activities to support the use of AI across the federal government: • GSA. The AI in Government Act of 2020 (AGA, Division U, Title I, of the Consolidated Appropriations Act, 2021, P.L. 116-260) created within GSA an AI Center of Excellence to facilitate the adoption of AI technologies in the federal government and collect and publicly publish information regarding federal programs, pilots, and other initiatives.43 • OMB. The AGA required OMB to issue a memorandum to federal agencies regarding the development of AI policies; approaches for removing barriers to using AI technologies; and best practices for identifying, assessing, and mitigating any discriminatory impact or bias and any unintended consequences of using AI. The Advancing American AI Act (Subtitle B of the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023, P.L. 117-263) required OMB to (1) incorporate additional considerations when developing guidance for the use of AI in the federal government; (2) develop an initial means to ensure that contracts for acquiring AI address privacy, civil rights and liberties, and the protection of government data and information; (3) require the head of each federal agency (except DOD) to prepare and maintain an inventory of current and planned AI use cases; and (4) lead a pilot program to initiate four new AI use case applications to support interagency or intra-agency modernization initiatives. Additionally, the AI Training Act (P.L. 117-207) required OMB to establish an AI training program for the acquisition workforce of executive agencies. • OPM. The AGA required OPM to establish or update an occupational job series to include positions with primary duties in AI and to estimate current and future numbers of federal employment positions related to AI at each agency. NDAAs have also included provisions focused on AI in the defense, national security, and intelligence communities each year beginning with the FY2019 John S. McCain NDAA, which included the first definition of AI in federal statute.44 These provisions have included a focus on AI development, acquisition, and policies; AI data repositories; recruiting and retaining personnel in AI; and implementation of recommendations from the 2021 final report of the National Security Commission on AI.45 Additionally, some enacted legislation has focused on AI R&D or the use of AI in particular federal programs. For example: • The CHIPS and Science Act (P.L. 117-167) included numerous AI-related provisions directing the Department of Energy, NIST, and NSF to support AI and ML R&D activities and the development of technical standards and guidelines related to safe and trustworthy AI systems. NSF was further directed to (1) evaluate the establishment of an AI scholarship-for-service program to recruit and train AI professionals to support AI work in federal, state, local, and tribal governments; and (2) study AI research capacity at U.S. institutions of higher education.
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Your responses are always thorough covering all bases to ensure the user has all the information they need, but you find a happy medium to not be to wordy. You always explain how you came to each conclusion and you only use the text that is provided to you to answer questions. AI technologies, including GenAI tools, have many potential benefits, such as accelerating and providing insights into data processing, augmenting human decisionmaking, and optimizing performance for complex systems and tasks. GenAI tools, for example, are increasingly capable of performing a broad range of tasks, such as text analysis, image generation, and speech recognition. However, AI systems may perpetuate or amplify biases in the datasets on which they are trained; may not yet be able to fully explain their decisionmaking; and often depend on such vast amounts of data and other resources that they are not widely accessible for research, development, and commercialization beyond a handful of technology companies. Numerous federal laws on AI have been enacted over the past few Congresses, either as standalone legislation or as AIfocused provisions in broader acts. These include the expansive National Artificial Intelligence Initiative Act of 2020 (Division E of P.L. 116-283), which included the establishment of an American AI Initiative and direction for AI research, development, and evaluation activities at federal science agencies. Additional acts have directed certain agencies to undertake activities to guide AI programs and policies across the federal government (e.g., the AI in Government Act of 2020, P.L. 116- 260; and the Advancing American AI Act, Subtitle B of P.L. 117-263). In the 117th Congress, at least 75 bills were introduced that either focused on AI and ML or had AI/ML-focused provisions. Six of those were enacted. In the 118th Congress, as of June 2023, at least 40 bills had been introduced that either focused on AI/ML or contained AI/ML-focused provisions, and none has been enacted. Collectively, bills in the 118th Congress address a range of topics, including federal government oversight of AI; training for federal employees; disclosure of AI use; export controls; usespecific prohibitions; and support for the use of AI in particular sectors, such as cybersecurity, weather modeling, wildfire detection, precision agriculture, and airport safety. AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. 17 Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in healthcare, as well as the importance of regulations.” 18 A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now.19 And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.”20 This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Federal laws addressing AI or including AI-focused provisions have been enacted over the past few Congresses. Arguably the most expansive law was the National Artificial Intelligence Initiative (NAII) Act of 2020 (Division E of the William M. (Mac) Thornberry National Defense Authorization Act [NDAA] of FY2021, P.L. 116-283). The NAII Act included sections • codifying the establishment of an American AI Initiative, • establishing a National Artificial Intelligence Initiative Office to support federal AI activities, • establishing an interagency committee at the Office of Science and Technology Policy to coordinate federal programs and activities in support of the NAII, and • establishing a National AI Advisory Committee. The NAII Act further directed AI activities at the National Science Foundation (NSF), National Institute of Standards and Technology (NIST),40 National Oceanic and Atmospheric Administration, and Department of Energy. Specific provisions include mandating (1) NSF support for a network of National AI Research Institutes; (2) a National Academies of Sciences, Engineering, and Medicine study on the current and future impact of AI on the U.S. workforce across sectors;41 and (3) a task force to investigate the feasibility of, and plan for, a National AI Research Resource.42 Individual agencies—including the General Services Administration (GSA), the Office of Management and Budget (OMB), and the Office of Personnel Management (OPM)—have also been statutorily directed to undertake activities to support the use of AI across the federal government: • GSA. The AI in Government Act of 2020 (AGA, Division U, Title I, of the Consolidated Appropriations Act, 2021, P.L. 116-260) created within GSA an AI Center of Excellence to facilitate the adoption of AI technologies in the federal government and collect and publicly publish information regarding federal programs, pilots, and other initiatives.43 • OMB. The AGA required OMB to issue a memorandum to federal agencies regarding the development of AI policies; approaches for removing barriers to using AI technologies; and best practices for identifying, assessing, and mitigating any discriminatory impact or bias and any unintended consequences of using AI. The Advancing American AI Act (Subtitle B of the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023, P.L. 117-263) required OMB to (1) incorporate additional considerations when developing guidance for the use of AI in the federal government; (2) develop an initial means to ensure that contracts for acquiring AI address privacy, civil rights and liberties, and the protection of government data and information; (3) require the head of each federal agency (except DOD) to prepare and maintain an inventory of current and planned AI use cases; and (4) lead a pilot program to initiate four new AI use case applications to support interagency or intra-agency modernization initiatives. Additionally, the AI Training Act (P.L. 117-207) required OMB to establish an AI training program for the acquisition workforce of executive agencies. • OPM. The AGA required OPM to establish or update an occupational job series to include positions with primary duties in AI and to estimate current and future numbers of federal employment positions related to AI at each agency. NDAAs have also included provisions focused on AI in the defense, national security, and intelligence communities each year beginning with the FY2019 John S. McCain NDAA, which included the first definition of AI in federal statute.44 These provisions have included a focus on AI development, acquisition, and policies; AI data repositories; recruiting and retaining personnel in AI; and implementation of recommendations from the 2021 final report of the National Security Commission on AI.45 Additionally, some enacted legislation has focused on AI R&D or the use of AI in particular federal programs. For example: • The CHIPS and Science Act (P.L. 117-167) included numerous AI-related provisions directing the Department of Energy, NIST, and NSF to support AI and ML R&D activities and the development of technical standards and guidelines related to safe and trustworthy AI systems. NSF was further directed to (1) evaluate the establishment of an AI scholarship-for-service program to recruit and train AI professionals to support AI work in federal, state, local, and tribal governments; and (2) study AI research capacity at U.S. institutions of higher education. What acronyms are mentioned?
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Your responses are always thorough covering all bases to ensure the user has all the information they need, but you find a happy medium to not be to wordy. You always explain how you came to each conclusion and you only use the text that is provided to you to answer questions.
EVIDENCE:
AI technologies, including GenAI tools, have many potential benefits, such as accelerating and providing insights into data processing, augmenting human decisionmaking, and optimizing performance for complex systems and tasks. GenAI tools, for example, are increasingly capable of performing a broad range of tasks, such as text analysis, image generation, and speech recognition. However, AI systems may perpetuate or amplify biases in the datasets on which they are trained; may not yet be able to fully explain their decisionmaking; and often depend on such vast amounts of data and other resources that they are not widely accessible for research, development, and commercialization beyond a handful of technology companies. Numerous federal laws on AI have been enacted over the past few Congresses, either as standalone legislation or as AIfocused provisions in broader acts. These include the expansive National Artificial Intelligence Initiative Act of 2020 (Division E of P.L. 116-283), which included the establishment of an American AI Initiative and direction for AI research, development, and evaluation activities at federal science agencies. Additional acts have directed certain agencies to undertake activities to guide AI programs and policies across the federal government (e.g., the AI in Government Act of 2020, P.L. 116- 260; and the Advancing American AI Act, Subtitle B of P.L. 117-263). In the 117th Congress, at least 75 bills were introduced that either focused on AI and ML or had AI/ML-focused provisions. Six of those were enacted. In the 118th Congress, as of June 2023, at least 40 bills had been introduced that either focused on AI/ML or contained AI/ML-focused provisions, and none has been enacted. Collectively, bills in the 118th Congress address a range of topics, including federal government oversight of AI; training for federal employees; disclosure of AI use; export controls; usespecific prohibitions; and support for the use of AI in particular sectors, such as cybersecurity, weather modeling, wildfire detection, precision agriculture, and airport safety. AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. 17 Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in healthcare, as well as the importance of regulations.” 18 A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now.19 And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.”20 This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Federal laws addressing AI or including AI-focused provisions have been enacted over the past few Congresses. Arguably the most expansive law was the National Artificial Intelligence Initiative (NAII) Act of 2020 (Division E of the William M. (Mac) Thornberry National Defense Authorization Act [NDAA] of FY2021, P.L. 116-283). The NAII Act included sections • codifying the establishment of an American AI Initiative, • establishing a National Artificial Intelligence Initiative Office to support federal AI activities, • establishing an interagency committee at the Office of Science and Technology Policy to coordinate federal programs and activities in support of the NAII, and • establishing a National AI Advisory Committee. The NAII Act further directed AI activities at the National Science Foundation (NSF), National Institute of Standards and Technology (NIST),40 National Oceanic and Atmospheric Administration, and Department of Energy. Specific provisions include mandating (1) NSF support for a network of National AI Research Institutes; (2) a National Academies of Sciences, Engineering, and Medicine study on the current and future impact of AI on the U.S. workforce across sectors;41 and (3) a task force to investigate the feasibility of, and plan for, a National AI Research Resource.42 Individual agencies—including the General Services Administration (GSA), the Office of Management and Budget (OMB), and the Office of Personnel Management (OPM)—have also been statutorily directed to undertake activities to support the use of AI across the federal government: • GSA. The AI in Government Act of 2020 (AGA, Division U, Title I, of the Consolidated Appropriations Act, 2021, P.L. 116-260) created within GSA an AI Center of Excellence to facilitate the adoption of AI technologies in the federal government and collect and publicly publish information regarding federal programs, pilots, and other initiatives.43 • OMB. The AGA required OMB to issue a memorandum to federal agencies regarding the development of AI policies; approaches for removing barriers to using AI technologies; and best practices for identifying, assessing, and mitigating any discriminatory impact or bias and any unintended consequences of using AI. The Advancing American AI Act (Subtitle B of the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023, P.L. 117-263) required OMB to (1) incorporate additional considerations when developing guidance for the use of AI in the federal government; (2) develop an initial means to ensure that contracts for acquiring AI address privacy, civil rights and liberties, and the protection of government data and information; (3) require the head of each federal agency (except DOD) to prepare and maintain an inventory of current and planned AI use cases; and (4) lead a pilot program to initiate four new AI use case applications to support interagency or intra-agency modernization initiatives. Additionally, the AI Training Act (P.L. 117-207) required OMB to establish an AI training program for the acquisition workforce of executive agencies. • OPM. The AGA required OPM to establish or update an occupational job series to include positions with primary duties in AI and to estimate current and future numbers of federal employment positions related to AI at each agency. NDAAs have also included provisions focused on AI in the defense, national security, and intelligence communities each year beginning with the FY2019 John S. McCain NDAA, which included the first definition of AI in federal statute.44 These provisions have included a focus on AI development, acquisition, and policies; AI data repositories; recruiting and retaining personnel in AI; and implementation of recommendations from the 2021 final report of the National Security Commission on AI.45 Additionally, some enacted legislation has focused on AI R&D or the use of AI in particular federal programs. For example: • The CHIPS and Science Act (P.L. 117-167) included numerous AI-related provisions directing the Department of Energy, NIST, and NSF to support AI and ML R&D activities and the development of technical standards and guidelines related to safe and trustworthy AI systems. NSF was further directed to (1) evaluate the establishment of an AI scholarship-for-service program to recruit and train AI professionals to support AI work in federal, state, local, and tribal governments; and (2) study AI research capacity at U.S. institutions of higher education.
USER:
What acronyms are mentioned?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 52 | 4 | 1,269 | null | 589 |
This task requires you to answer questions based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge.
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What was the first circuits ruling on the United States v Evans?
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Funding Limitations on Medical Marijuana Prosecutions In each fiscal year since FY2015, Congress has included provisions in appropriations acts that prohibit DOJ from using appropriated funds to prevent certain states and territories and the District of Columbia from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” The FY2024 provision lists 52 jurisdictions, including every U.S. jurisdiction that had legalized medical cannabis use at the time it was enacted. On its face, the appropriations rider bars DOJ from taking legal action against the states directly in order to prevent them from promulgating or enforcing medical marijuana laws. In addition, federal courts have interpreted the rider to prohibit certain federal prosecutions of private individuals or organizations that Congressional Research Service 3 produce, distribute, or possess marijuana in accordance with state medical marijuana laws. In those cases, criminal defendants have invoked the rider before trial, seeking either the dismissal of their indictments or injunctions barring prosecution. By contrast, courts have generally declined to apply the rider outside the context of initial criminal prosecutions. For instance, the Ninth Circuit has held that the provision does not “impact[ ] the ability of a federal district court to restrict the use of medical marijuana as a condition of probation.” In the 2016 case United States v. McIntosh, the U.S. Court of Appeals for the Ninth Circuit considered the circumstances in which the appropriations rider bars CSA prosecution of marijuana-related activities. The court held that the rider prohibits the federal government only from preventing the implementation of those specific rules of state law that authorize the use, distribution, possession, or cultivation of medical marijuana. DOJ does not prevent the implementation of [such rules] when it prosecutes individuals who engage in conduct unauthorized under state medical marijuana laws. Individuals who do not strictly comply with all state-law conditions regarding the use, distribution, possession, and cultivation of medical marijuana have engaged in conduct that is unauthorized, and prosecuting such individuals does not violate [the rider]. Relying on McIntosh, the Ninth Circuit has issued several decisions allowing federal prosecution of individuals who did not “strictly comply” with state medical marijuana laws, notwithstanding the appropriations rider, and several district courts have followed that reasoning. As one example, in United States v. Evans, the Ninth Circuit upheld the prosecution of two individuals involved in the production of medical marijuana who smoked marijuana as they processed plants for sale. Although state law permitted medical marijuana use by “qualifying patients,” the court concluded that the defendants failed to show they were qualifying patients, and thus they could be prosecuted because their personal marijuana use did not strictly comply with state medical marijuana law. In the 2022 case United States v. Bilodeau, the U.S. Court of Appeals for the First Circuit also considered the scope of the appropriations rider. The defendants in Bilodeau were registered with the State of Maine to produce medical marijuana, but DOJ alleged that they distributed large quantities of marijuana to individuals who were not qualifying patients under Maine law, including recipients in other states. Following indictment for criminal CSA violations, the defendants sought to invoke the appropriations rider to bar their prosecutions. They argued that the rider “must be read to preclude the DOJ, under most circumstances, from prosecuting persons who possess state licenses to partake in medical marijuana activity.” DOJ instead urged the court to apply the Ninth Circuit’s standard, allowing prosecution unless the defendants could show that they acted in strict compliance with state medical marijuana laws. The First Circuit declined to adopt either of the proposed tests. As an initial matter, the court agreed with the Ninth Circuit that the rider means “DOJ may not spend funds to bring prosecutions if doing so prevents a state from giving practical effect to its medical marijuana laws.” However, the panel declined to adopt the Ninth Circuit’s holding that the rider bars prosecution only in cases where defendants strictly complied with state law. The court noted that the text of the rider does not explicitly require strict compliance with state law and that, given the complexity of state marijuana regulations, “the potential for technical noncompliance [with state law] is real enough that no person through any reasonable effort could always assure strict compliance.” Thus, the First Circuit concluded that requiring strict compliance with state law would likely chill state-legal medical marijuana activities and prevent the states from giving effect to their medical marijuana laws. On the other hand, the court also rejected the defendants’ more expansive reading of the rider, reasoning that “Congress surely did not intend for the rider to provide a safe harbor to all caregivers with facially valid documents without regard for blatantly illegitimate activity.” Ultimately, while the First Circuit held that the rider bars CSA prosecution in at least some cases where the defendant has committed minor technical violations of state medical marijuana laws, it declined to Congressional Research Service 4 “fully define [the] precise boundaries” of its alternative standard. On the record before it, the court concluded that “the defendants’ cultivation, possession, and distribution of marijuana aimed at supplying persons whom no defendant ever thought were qualifying patients under Maine law” and that a CSA conviction in those circumstances would not “prevent Maine’s medical marijuana laws from having their intended practical effect.” Considerations for Congress It remains to be seen whether and how the difference in reasoning between the Ninth Circuit and the First Circuit will make a practical difference in federal marijuana prosecutions. In theory, the First Circuit’s analysis could make it easier for defendants to invoke the appropriations rider to bar federal prosecutions, because they could do so even if they had not been in strict compliance with state law. In practice, however, resource limitations and enforcement priorities have historically meant that federal marijuana prosecutions target only individuals and organizations that have clearly not complied with state law. Thus, one of the First Circuit judges who considered Bilodeau agreed with the panel’s interpretation of the rider but wrote a concurrence noting that, in practice, the First Circuit’s standard might not be “materially different from the one that the Ninth Circuit applied.” While the medical marijuana appropriations rider restricts DOJ’s ability to bring some marijuana prosecutions, its effect is limited in several ways. First, marijuana-related activities that fall outside the scope of the appropriations rider remain subject to prosecution under the CSA. By its terms, the rider applies only to state laws related to medical marijuana; it does not bar prosecution of any activities related to recreational marijuana, even if those activities are permitted under state law. Second, as the Ninth Circuit has explained, even where the rider does apply, it “does not provide immunity from prosecution for federal marijuana offenses”—it simply restricts DOJ’s ability to expend funds to enforce federal law for as long as it remains in effect. If Congress instead opted to repeal the rider or allow it to lapse, DOJ would be able to prosecute future CSA violations as well as past violations that occurred while the rider was in effect, subject to the applicable statute of limitations. Third, participants in the cannabis industry may face numerous collateral consequences arising from the federal prohibition of marijuana in areas including bankruptcy, taxation, and immigration. Many of those legal consequences attach regardless of whether a person is charged with or convicted of a CSA offense, meaning the rider would not affect them. Because the medical marijuana appropriations rider applies to marijuana specifically, regardless of how the substance is classified under the CSA, rescheduling marijuana would not affect the rider. Congress has the authority to enact legislation to clarify or alter the scope of the appropriations rider, repeal the rider, or decline to include it in future appropriations laws. For instance, Congress could amend the rider to specify whether strict compliance with state medical marijuana law is required in order to bar prosecution under the CSA or provide a different standard that DOJ and the courts should apply. Beyond the appropriations context, Congress could also consider other changes to federal marijuana law that would affect its interaction with state law. Such changes could take the form of more stringent marijuana regulation—for instance, through increased DOJ funding to prosecute CSA violations or limiting federal funds for states that legalize marijuana. In contrast, most recent proposals before Congress seek to relax federal restrictions on marijuana or mitigate the disparity between federal and state marijuana regulation.
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System Instructions: [This task requires you to answer questions based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge.] Question: [What was the first circuits ruling on the United States v Evans?] Context Block: [Funding Limitations on Medical Marijuana Prosecutions In each fiscal year since FY2015, Congress has included provisions in appropriations acts that prohibit DOJ from using appropriated funds to prevent certain states and territories and the District of Columbia from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” The FY2024 provision lists 52 jurisdictions, including every U.S. jurisdiction that had legalized medical cannabis use at the time it was enacted. On its face, the appropriations rider bars DOJ from taking legal action against the states directly in order to prevent them from promulgating or enforcing medical marijuana laws. In addition, federal courts have interpreted the rider to prohibit certain federal prosecutions of private individuals or organizations that Congressional Research Service 3 produce, distribute, or possess marijuana in accordance with state medical marijuana laws. In those cases, criminal defendants have invoked the rider before trial, seeking either the dismissal of their indictments or injunctions barring prosecution. By contrast, courts have generally declined to apply the rider outside the context of initial criminal prosecutions. For instance, the Ninth Circuit has held that the provision does not “impact[ ] the ability of a federal district court to restrict the use of medical marijuana as a condition of probation.” In the 2016 case United States v. McIntosh, the U.S. Court of Appeals for the Ninth Circuit considered the circumstances in which the appropriations rider bars CSA prosecution of marijuana-related activities. The court held that the rider prohibits the federal government only from preventing the implementation of those specific rules of state law that authorize the use, distribution, possession, or cultivation of medical marijuana. DOJ does not prevent the implementation of [such rules] when it prosecutes individuals who engage in conduct unauthorized under state medical marijuana laws. Individuals who do not strictly comply with all state-law conditions regarding the use, distribution, possession, and cultivation of medical marijuana have engaged in conduct that is unauthorized, and prosecuting such individuals does not violate [the rider]. Relying on McIntosh, the Ninth Circuit has issued several decisions allowing federal prosecution of individuals who did not “strictly comply” with state medical marijuana laws, notwithstanding the appropriations rider, and several district courts have followed that reasoning. As one example, in United States v. Evans, the Ninth Circuit upheld the prosecution of two individuals involved in the production of medical marijuana who smoked marijuana as they processed plants for sale. Although state law permitted medical marijuana use by “qualifying patients,” the court concluded that the defendants failed to show they were qualifying patients, and thus they could be prosecuted because their personal marijuana use did not strictly comply with state medical marijuana law. In the 2022 case United States v. Bilodeau, the U.S. Court of Appeals for the First Circuit also considered the scope of the appropriations rider. The defendants in Bilodeau were registered with the State of Maine to produce medical marijuana, but DOJ alleged that they distributed large quantities of marijuana to individuals who were not qualifying patients under Maine law, including recipients in other states. Following indictment for criminal CSA violations, the defendants sought to invoke the appropriations rider to bar their prosecutions. They argued that the rider “must be read to preclude the DOJ, under most circumstances, from prosecuting persons who possess state licenses to partake in medical marijuana activity.” DOJ instead urged the court to apply the Ninth Circuit’s standard, allowing prosecution unless the defendants could show that they acted in strict compliance with state medical marijuana laws. The First Circuit declined to adopt either of the proposed tests. As an initial matter, the court agreed with the Ninth Circuit that the rider means “DOJ may not spend funds to bring prosecutions if doing so prevents a state from giving practical effect to its medical marijuana laws.” However, the panel declined to adopt the Ninth Circuit’s holding that the rider bars prosecution only in cases where defendants strictly complied with state law. The court noted that the text of the rider does not explicitly require strict compliance with state law and that, given the complexity of state marijuana regulations, “the potential for technical noncompliance [with state law] is real enough that no person through any reasonable effort could always assure strict compliance.” Thus, the First Circuit concluded that requiring strict compliance with state law would likely chill state-legal medical marijuana activities and prevent the states from giving effect to their medical marijuana laws. On the other hand, the court also rejected the defendants’ more expansive reading of the rider, reasoning that “Congress surely did not intend for the rider to provide a safe harbor to all caregivers with facially valid documents without regard for blatantly illegitimate activity.” Ultimately, while the First Circuit held that the rider bars CSA prosecution in at least some cases where the defendant has committed minor technical violations of state medical marijuana laws, it declined to Congressional Research Service 4 “fully define [the] precise boundaries” of its alternative standard. On the record before it, the court concluded that “the defendants’ cultivation, possession, and distribution of marijuana aimed at supplying persons whom no defendant ever thought were qualifying patients under Maine law” and that a CSA conviction in those circumstances would not “prevent Maine’s medical marijuana laws from having their intended practical effect.” Considerations for Congress It remains to be seen whether and how the difference in reasoning between the Ninth Circuit and the First Circuit will make a practical difference in federal marijuana prosecutions. In theory, the First Circuit’s analysis could make it easier for defendants to invoke the appropriations rider to bar federal prosecutions, because they could do so even if they had not been in strict compliance with state law. In practice, however, resource limitations and enforcement priorities have historically meant that federal marijuana prosecutions target only individuals and organizations that have clearly not complied with state law. Thus, one of the First Circuit judges who considered Bilodeau agreed with the panel’s interpretation of the rider but wrote a concurrence noting that, in practice, the First Circuit’s standard might not be “materially different from the one that the Ninth Circuit applied.” While the medical marijuana appropriations rider restricts DOJ’s ability to bring some marijuana prosecutions, its effect is limited in several ways. First, marijuana-related activities that fall outside the scope of the appropriations rider remain subject to prosecution under the CSA. By its terms, the rider applies only to state laws related to medical marijuana; it does not bar prosecution of any activities related to recreational marijuana, even if those activities are permitted under state law. Second, as the Ninth Circuit has explained, even where the rider does apply, it “does not provide immunity from prosecution for federal marijuana offenses”—it simply restricts DOJ’s ability to expend funds to enforce federal law for as long as it remains in effect. If Congress instead opted to repeal the rider or allow it to lapse, DOJ would be able to prosecute future CSA violations as well as past violations that occurred while the rider was in effect, subject to the applicable statute of limitations. Third, participants in the cannabis industry may face numerous collateral consequences arising from the federal prohibition of marijuana in areas including bankruptcy, taxation, and immigration. Many of those legal consequences attach regardless of whether a person is charged with or convicted of a CSA offense, meaning the rider would not affect them. Because the medical marijuana appropriations rider applies to marijuana specifically, regardless of how the substance is classified under the CSA, rescheduling marijuana would not affect the rider. Congress has the authority to enact legislation to clarify or alter the scope of the appropriations rider, repeal the rider, or decline to include it in future appropriations laws. For instance, Congress could amend the rider to specify whether strict compliance with state medical marijuana law is required in order to bar prosecution under the CSA or provide a different standard that DOJ and the courts should apply. Beyond the appropriations context, Congress could also consider other changes to federal marijuana law that would affect its interaction with state law. Such changes could take the form of more stringent marijuana regulation—for instance, through increased DOJ funding to prosecute CSA violations or limiting federal funds for states that legalize marijuana. In contrast, most recent proposals before Congress seek to relax federal restrictions on marijuana or mitigate the disparity between federal and state marijuana regulation. ]
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This task requires you to answer questions based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge.
EVIDENCE:
Funding Limitations on Medical Marijuana Prosecutions In each fiscal year since FY2015, Congress has included provisions in appropriations acts that prohibit DOJ from using appropriated funds to prevent certain states and territories and the District of Columbia from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” The FY2024 provision lists 52 jurisdictions, including every U.S. jurisdiction that had legalized medical cannabis use at the time it was enacted. On its face, the appropriations rider bars DOJ from taking legal action against the states directly in order to prevent them from promulgating or enforcing medical marijuana laws. In addition, federal courts have interpreted the rider to prohibit certain federal prosecutions of private individuals or organizations that Congressional Research Service 3 produce, distribute, or possess marijuana in accordance with state medical marijuana laws. In those cases, criminal defendants have invoked the rider before trial, seeking either the dismissal of their indictments or injunctions barring prosecution. By contrast, courts have generally declined to apply the rider outside the context of initial criminal prosecutions. For instance, the Ninth Circuit has held that the provision does not “impact[ ] the ability of a federal district court to restrict the use of medical marijuana as a condition of probation.” In the 2016 case United States v. McIntosh, the U.S. Court of Appeals for the Ninth Circuit considered the circumstances in which the appropriations rider bars CSA prosecution of marijuana-related activities. The court held that the rider prohibits the federal government only from preventing the implementation of those specific rules of state law that authorize the use, distribution, possession, or cultivation of medical marijuana. DOJ does not prevent the implementation of [such rules] when it prosecutes individuals who engage in conduct unauthorized under state medical marijuana laws. Individuals who do not strictly comply with all state-law conditions regarding the use, distribution, possession, and cultivation of medical marijuana have engaged in conduct that is unauthorized, and prosecuting such individuals does not violate [the rider]. Relying on McIntosh, the Ninth Circuit has issued several decisions allowing federal prosecution of individuals who did not “strictly comply” with state medical marijuana laws, notwithstanding the appropriations rider, and several district courts have followed that reasoning. As one example, in United States v. Evans, the Ninth Circuit upheld the prosecution of two individuals involved in the production of medical marijuana who smoked marijuana as they processed plants for sale. Although state law permitted medical marijuana use by “qualifying patients,” the court concluded that the defendants failed to show they were qualifying patients, and thus they could be prosecuted because their personal marijuana use did not strictly comply with state medical marijuana law. In the 2022 case United States v. Bilodeau, the U.S. Court of Appeals for the First Circuit also considered the scope of the appropriations rider. The defendants in Bilodeau were registered with the State of Maine to produce medical marijuana, but DOJ alleged that they distributed large quantities of marijuana to individuals who were not qualifying patients under Maine law, including recipients in other states. Following indictment for criminal CSA violations, the defendants sought to invoke the appropriations rider to bar their prosecutions. They argued that the rider “must be read to preclude the DOJ, under most circumstances, from prosecuting persons who possess state licenses to partake in medical marijuana activity.” DOJ instead urged the court to apply the Ninth Circuit’s standard, allowing prosecution unless the defendants could show that they acted in strict compliance with state medical marijuana laws. The First Circuit declined to adopt either of the proposed tests. As an initial matter, the court agreed with the Ninth Circuit that the rider means “DOJ may not spend funds to bring prosecutions if doing so prevents a state from giving practical effect to its medical marijuana laws.” However, the panel declined to adopt the Ninth Circuit’s holding that the rider bars prosecution only in cases where defendants strictly complied with state law. The court noted that the text of the rider does not explicitly require strict compliance with state law and that, given the complexity of state marijuana regulations, “the potential for technical noncompliance [with state law] is real enough that no person through any reasonable effort could always assure strict compliance.” Thus, the First Circuit concluded that requiring strict compliance with state law would likely chill state-legal medical marijuana activities and prevent the states from giving effect to their medical marijuana laws. On the other hand, the court also rejected the defendants’ more expansive reading of the rider, reasoning that “Congress surely did not intend for the rider to provide a safe harbor to all caregivers with facially valid documents without regard for blatantly illegitimate activity.” Ultimately, while the First Circuit held that the rider bars CSA prosecution in at least some cases where the defendant has committed minor technical violations of state medical marijuana laws, it declined to Congressional Research Service 4 “fully define [the] precise boundaries” of its alternative standard. On the record before it, the court concluded that “the defendants’ cultivation, possession, and distribution of marijuana aimed at supplying persons whom no defendant ever thought were qualifying patients under Maine law” and that a CSA conviction in those circumstances would not “prevent Maine’s medical marijuana laws from having their intended practical effect.” Considerations for Congress It remains to be seen whether and how the difference in reasoning between the Ninth Circuit and the First Circuit will make a practical difference in federal marijuana prosecutions. In theory, the First Circuit’s analysis could make it easier for defendants to invoke the appropriations rider to bar federal prosecutions, because they could do so even if they had not been in strict compliance with state law. In practice, however, resource limitations and enforcement priorities have historically meant that federal marijuana prosecutions target only individuals and organizations that have clearly not complied with state law. Thus, one of the First Circuit judges who considered Bilodeau agreed with the panel’s interpretation of the rider but wrote a concurrence noting that, in practice, the First Circuit’s standard might not be “materially different from the one that the Ninth Circuit applied.” While the medical marijuana appropriations rider restricts DOJ’s ability to bring some marijuana prosecutions, its effect is limited in several ways. First, marijuana-related activities that fall outside the scope of the appropriations rider remain subject to prosecution under the CSA. By its terms, the rider applies only to state laws related to medical marijuana; it does not bar prosecution of any activities related to recreational marijuana, even if those activities are permitted under state law. Second, as the Ninth Circuit has explained, even where the rider does apply, it “does not provide immunity from prosecution for federal marijuana offenses”—it simply restricts DOJ’s ability to expend funds to enforce federal law for as long as it remains in effect. If Congress instead opted to repeal the rider or allow it to lapse, DOJ would be able to prosecute future CSA violations as well as past violations that occurred while the rider was in effect, subject to the applicable statute of limitations. Third, participants in the cannabis industry may face numerous collateral consequences arising from the federal prohibition of marijuana in areas including bankruptcy, taxation, and immigration. Many of those legal consequences attach regardless of whether a person is charged with or convicted of a CSA offense, meaning the rider would not affect them. Because the medical marijuana appropriations rider applies to marijuana specifically, regardless of how the substance is classified under the CSA, rescheduling marijuana would not affect the rider. Congress has the authority to enact legislation to clarify or alter the scope of the appropriations rider, repeal the rider, or decline to include it in future appropriations laws. For instance, Congress could amend the rider to specify whether strict compliance with state medical marijuana law is required in order to bar prosecution under the CSA or provide a different standard that DOJ and the courts should apply. Beyond the appropriations context, Congress could also consider other changes to federal marijuana law that would affect its interaction with state law. Such changes could take the form of more stringent marijuana regulation—for instance, through increased DOJ funding to prosecute CSA violations or limiting federal funds for states that legalize marijuana. In contrast, most recent proposals before Congress seek to relax federal restrictions on marijuana or mitigate the disparity between federal and state marijuana regulation.
USER:
What was the first circuits ruling on the United States v Evans?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 31 | 12 | 1,407 | null | 833 |
Base your response only on the document provided. List them in bullet point format. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context".
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At week 8, what urological changes were observed in the experimental group of mice (injected with ketamine)?
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**Changes to the bladder epithelial barrier are associated with ketamine-induced cystitis - Results ** Animals and ketamine administration A total of 60 8-week-old female C57BL/6 mice (weight, 19.08±1.29 g) were obtained from Renming Hospital of Wuhan University Laboratory Animal Center (Wuhan, China). Mice were maintained under a 12-h light/dark cycle at a constant temperature (21–22°C) and humidity (50%). Mice had free access to food and tap water prior to the experiments. Mice were randomly allocated into two groups, control group and ketamine treatment group, and the mice in each group were subsequently subdivided into three subgroups (4, 8 and 12 week groups; n=10 mice/subgroup). Mice received daily intraperitoneal injections of saline (control group) or 100 mg/kg ketamine (Gutian Fuxing Pharmaceutical Co., Ltd., Gutian, China) (ketamine treatment group) to model the effects of repeated ketamine abuse, which was previously described in a study by Meng et al (15). Micturition behavior Micturition frequency was determined as previously described in a study by Gu et al (10). In brief, short-term micturition frequency of freely moving mice was observed at the end of 4, 8 and 12 weeks of treatment. At the end of the 4, 8 and 12 weeks, respectively, mice were placed in five separate square lattices containing a gridded filter paper pad, with each small grid containing a mouse. Filter paper was impregnated with saturated copper sulfate solution (CuSO4 5H2O) and dehydrated at 200°C for 1 h prior to use. When urine fell onto this filter paper, the anhydrous CuSO4 was rehydrated and turned blue. Subsequent to 2 h, the numbers of urine spots >0.2 cm in diameter were counted and recorded by five people independently with ultraviolet illumination. Histopathological and immunohistochemical analysis Mice were sacrificed with an intraperitoneal injection of sodium pentobarbital (100 mg/kg, Sigma-Aldrich; Merck KGaA, Germany) and bladders were excised for analyses. For histopathlogical analysis, half of the bladder tissues were fixed in 4% phosphate-buffered paraformaldehyde overnight at room temperature, dehydrated in serial ethanol concentrations, cleared in xylene and embedded into paraffin wax. Serial paraffin sections of 5 µm in thickness were created, stained with haematoxylin and eosin and subsequently examined under a light microscope (Nikon Corp., Tokyo, Japan). For immunohistochemical analysis, tissue sections were dewaxed and rehydrated with graded xylene and serial ethanol concentrations. Subsequently, immunohistochemical labeling for zonula occludens-1 (ZO-1) was performed. Following the blocking of nonspecific antibody activity using Tris-buffered saline (Sigma-Aldrich; Merck KGaA) containing 1% bovine serum albumin and 10% fetal calf serum at 37°C for 2 h, the tissue sections were incubated with primary antibody anti-ZO-1 (BSA-1543, 1:100 dilution; BioGenex, San Ramon, CA, USA) overnight at 4°C. Subsequently, hydrogen peroxide was used to eliminate the endogenous peroxidase activity at 37°C for 10 min. The distribution of ZO-1 marker was scored into two levels by two independent histologists: Normal and abnormal. If normal, the ZO-1 marker was distributed throughout the urothelium and more intensely under the umbrella cell layer with minimal expression in the cytoplasm. If abnormal, the distribution of the ZO-1 marker was patchy, absent, or expressed in the cytoplasm and not localized on cell surfaces. Ultrastructure of bladder samples For ultrastructure analysis, half of the bladder tissue samples from each mouse were fixed in 2.5% glutaraldehyde buffered in 0.1 M phosphate buffer, post-fixed in buffered 1% osmium tetroxide, dehydrated using ascending grades of ethanol and dry acetone, embedded in epoxy resin, and finally left in a resin-polymerizing oven overnight at 65°C. The protocol for ultrastructure analysis was in accordance with the method published in the study by Jeong et al (16) with some modifications. Ultrathin sections of 70 nm in thickness were created, mounted on 200-mesh hexagonal copper grids and stained with lead citrate. The ultrastructural urothelium of the bladder samples was observed using a Hitachi H-600 transmission electron microscope (TEM; Hitachi, Ltd., Tokyo, Japan). Statistical analysis Data are expressed as the mean ± standard error of the mean. Statistical analyses were performed using Prism v.5.0 software (GraphPad Software, Inc., La Jolla, CA, USA). Independent-samples t-tests were used to detect significant differences in micturition frequency between two groups. Fisher's exact test was used to measure any significant differences in ZO-1 expression. P<0.05 was considered to indicate a statistically significant difference. Go to: Results Micturition behavior As exhibited in Fig. 1, the micturition frequency in the ketamine-treated and control groups were determined as 8.05+1.799 and 8.36+1.492 following 4 weeks of treatment, and there was no significant difference in micturition frequency between the two groups at this time point (P>0.05). However, following 8 weeks of treatment, the micturition frequency in the ketamine-treated group was determined as 11.90+3.348 and was significantly increased compared with that of the control group (8.50+1.581; P<0.01). Similar results were obtained for the micturition frequency in the ketamine-treated group (15.30+4.423) following 12 weeks of treatment, and this was significantly higher than that of the control group (8.50+1.581; P=0.001). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g00.jpg Figure 1. Micturition frequency of freely moving mice measured in a 2-h time period. Data are presented as the mean ± standard error of the mean. **P<0.05 and ***P<0.01. Bladder pathology and immunohistochemistry The urinary bladders of the ketamine-treated mice displayed some pathology differences when compared with the controls. When compared with the control group (Fig. 2A), there was no significant inflammatory cell infiltration and arterial dilatation following 4 weeks of ketamine treatment (Fig. 2B); however, arterial dilatation and congestion were observed under the submucosal epithelium of the urinary bladder following 8 weeks of ketamine treatment (indicated by arrows; Fig. 2C). In addition to the above symptoms, inflammatory cells, predominantly lymphocytes and occasionally macrophages, had infiltrated into the submucosal epithelium of the urinary bladders of mice in the ketamine-treated group after 12 weeks of treatment (indicated by arrows; Fig. 2D). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g01.jpg Figure 2. Haematoxylin and eosin staining of midsagittal sections of murine bladders. Bladder sections from (A) the control group (magnification, ×400), (B) ketamine-treated mice following 4 weeks of treatment (magnification, ×400), (C) ketamine-treated mice following 8 weeks of treatment (magnification, ×200) and (D) ketamine-treated mice following 12 weeks of treatment (magnification, ×400). ZO-1 was localized to the superficial umbrella cell layer at the apicolateral junction in the majority of control group samples (Fig. 3A); however, in the ketamine treatment groups, bladders exhibited a heterogeneous staining distribution, indicating that ZO-1 was distributed in the cytoplasm and was not absent or organized into tight junction structures (Fig. 3B). Additionally, the number of samples exhibiting abnormal ZO-1 distribution in the ketamine-treated group was increased compared with control group, with abnormal ZO-1 distribution in 70 vs. 0% (P=0.003) following 4 weeks, 70 vs. 10% (P=0.022) following 8 weeks and 90 vs. 10% (P=0.001) following 12 weeks of treatment in the ketamine-treated and control groups, respectively (Table I). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g02.jpg Figure 3. Representative immunohistochemical images of ZO-1 protein. For immunohistochemical analysis, tissue sections were incubated with primary antibody anti-ZO-1 overnight at 4°C. (A) In control mice, ZO-1 was localized to superficial umbrella cell layer at the interendothelial junctions in most samples. (B) In the ketamine group, ZO-1 located in the cytoplasm and not organized into tight junction structures, or absent. Magnification, ×200; scale bar, 100 µm. ZO-1, zonula occludens-1. Table I. Distribution of ZO-1 protein in each group. Treatment duration (weeks) ZO-1 distribution Ketamine (%) Control (%) P-valuea 4 0.003 Normal 3 (30) 10 (100) Abnormal 7 (70) 0 (0) 8 0.022 Normal 3 (30) 9 (90) Abnormal 7 (70) 1 (10) 12 0.001 Normal 1 (10) 9 (90) Abnormal 9 (90) 1 (10) Open in a separate window aFisher's exact test. ZO-1, zona occludens-1. Ultrastructure of bladder samples Morphological ultrastructural alterations to the uroepithelium and lamina propria of bladder cells were determined using TEM. As demonstrated in Fig. 4A-D, the surface of the umbrella cells in the control group were suffused with raised microplicae (indicated by arrows in Fig. 4A and B) and the cytoplasm of these cells contained multiple subapical vesicles (indicated with asterisks in Fig. 4B). Marked changes in bladder morphology were observed in the ketamine-treated group compared with the control group. The surface of the umbrella cells appeared more flattened following 4 (Fig. 4E-H) and 8 weeks (Fig. 4I-L), and even diminished following 12 weeks (Fig. 4M-P), of treatment in the ketamine-treated group compared with the control group. Thin tight junction complexes were frequently observed between the umbrella cells following 4 weeks of treatment in the ketamine-treated group (Fig. 4G); however, these distinct junction complexes were not observed following 8 and 12 weeks of ketamine treatment (Fig. 4K and O). In addition, the vascular endothelial cells exhibited cell body shrinkage, increased cytoplasm density and chromatin condensation following 8 weeks (Fig. 4L) and layer denudation following 12 weeks (Fig. 4P) of ketamine treatment.
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<Article> ================== **Changes to the bladder epithelial barrier are associated with ketamine-induced cystitis - Results ** Animals and ketamine administration A total of 60 8-week-old female C57BL/6 mice (weight, 19.08±1.29 g) were obtained from Renming Hospital of Wuhan University Laboratory Animal Center (Wuhan, China). Mice were maintained under a 12-h light/dark cycle at a constant temperature (21–22°C) and humidity (50%). Mice had free access to food and tap water prior to the experiments. Mice were randomly allocated into two groups, control group and ketamine treatment group, and the mice in each group were subsequently subdivided into three subgroups (4, 8 and 12 week groups; n=10 mice/subgroup). Mice received daily intraperitoneal injections of saline (control group) or 100 mg/kg ketamine (Gutian Fuxing Pharmaceutical Co., Ltd., Gutian, China) (ketamine treatment group) to model the effects of repeated ketamine abuse, which was previously described in a study by Meng et al (15). Micturition behavior Micturition frequency was determined as previously described in a study by Gu et al (10). In brief, short-term micturition frequency of freely moving mice was observed at the end of 4, 8 and 12 weeks of treatment. At the end of the 4, 8 and 12 weeks, respectively, mice were placed in five separate square lattices containing a gridded filter paper pad, with each small grid containing a mouse. Filter paper was impregnated with saturated copper sulfate solution (CuSO4 5H2O) and dehydrated at 200°C for 1 h prior to use. When urine fell onto this filter paper, the anhydrous CuSO4 was rehydrated and turned blue. Subsequent to 2 h, the numbers of urine spots >0.2 cm in diameter were counted and recorded by five people independently with ultraviolet illumination. Histopathological and immunohistochemical analysis Mice were sacrificed with an intraperitoneal injection of sodium pentobarbital (100 mg/kg, Sigma-Aldrich; Merck KGaA, Germany) and bladders were excised for analyses. For histopathlogical analysis, half of the bladder tissues were fixed in 4% phosphate-buffered paraformaldehyde overnight at room temperature, dehydrated in serial ethanol concentrations, cleared in xylene and embedded into paraffin wax. Serial paraffin sections of 5 µm in thickness were created, stained with haematoxylin and eosin and subsequently examined under a light microscope (Nikon Corp., Tokyo, Japan). For immunohistochemical analysis, tissue sections were dewaxed and rehydrated with graded xylene and serial ethanol concentrations. Subsequently, immunohistochemical labeling for zonula occludens-1 (ZO-1) was performed. Following the blocking of nonspecific antibody activity using Tris-buffered saline (Sigma-Aldrich; Merck KGaA) containing 1% bovine serum albumin and 10% fetal calf serum at 37°C for 2 h, the tissue sections were incubated with primary antibody anti-ZO-1 (BSA-1543, 1:100 dilution; BioGenex, San Ramon, CA, USA) overnight at 4°C. Subsequently, hydrogen peroxide was used to eliminate the endogenous peroxidase activity at 37°C for 10 min. The distribution of ZO-1 marker was scored into two levels by two independent histologists: Normal and abnormal. If normal, the ZO-1 marker was distributed throughout the urothelium and more intensely under the umbrella cell layer with minimal expression in the cytoplasm. If abnormal, the distribution of the ZO-1 marker was patchy, absent, or expressed in the cytoplasm and not localized on cell surfaces. Ultrastructure of bladder samples For ultrastructure analysis, half of the bladder tissue samples from each mouse were fixed in 2.5% glutaraldehyde buffered in 0.1 M phosphate buffer, post-fixed in buffered 1% osmium tetroxide, dehydrated using ascending grades of ethanol and dry acetone, embedded in epoxy resin, and finally left in a resin-polymerizing oven overnight at 65°C. The protocol for ultrastructure analysis was in accordance with the method published in the study by Jeong et al (16) with some modifications. Ultrathin sections of 70 nm in thickness were created, mounted on 200-mesh hexagonal copper grids and stained with lead citrate. The ultrastructural urothelium of the bladder samples was observed using a Hitachi H-600 transmission electron microscope (TEM; Hitachi, Ltd., Tokyo, Japan). Statistical analysis Data are expressed as the mean ± standard error of the mean. Statistical analyses were performed using Prism v.5.0 software (GraphPad Software, Inc., La Jolla, CA, USA). Independent-samples t-tests were used to detect significant differences in micturition frequency between two groups. Fisher's exact test was used to measure any significant differences in ZO-1 expression. P<0.05 was considered to indicate a statistically significant difference. Go to: Results Micturition behavior As exhibited in Fig. 1, the micturition frequency in the ketamine-treated and control groups were determined as 8.05+1.799 and 8.36+1.492 following 4 weeks of treatment, and there was no significant difference in micturition frequency between the two groups at this time point (P>0.05). However, following 8 weeks of treatment, the micturition frequency in the ketamine-treated group was determined as 11.90+3.348 and was significantly increased compared with that of the control group (8.50+1.581; P<0.01). Similar results were obtained for the micturition frequency in the ketamine-treated group (15.30+4.423) following 12 weeks of treatment, and this was significantly higher than that of the control group (8.50+1.581; P=0.001). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g00.jpg Figure 1. Micturition frequency of freely moving mice measured in a 2-h time period. Data are presented as the mean ± standard error of the mean. **P<0.05 and ***P<0.01. Bladder pathology and immunohistochemistry The urinary bladders of the ketamine-treated mice displayed some pathology differences when compared with the controls. When compared with the control group (Fig. 2A), there was no significant inflammatory cell infiltration and arterial dilatation following 4 weeks of ketamine treatment (Fig. 2B); however, arterial dilatation and congestion were observed under the submucosal epithelium of the urinary bladder following 8 weeks of ketamine treatment (indicated by arrows; Fig. 2C). In addition to the above symptoms, inflammatory cells, predominantly lymphocytes and occasionally macrophages, had infiltrated into the submucosal epithelium of the urinary bladders of mice in the ketamine-treated group after 12 weeks of treatment (indicated by arrows; Fig. 2D). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g01.jpg Figure 2. Haematoxylin and eosin staining of midsagittal sections of murine bladders. Bladder sections from (A) the control group (magnification, ×400), (B) ketamine-treated mice following 4 weeks of treatment (magnification, ×400), (C) ketamine-treated mice following 8 weeks of treatment (magnification, ×200) and (D) ketamine-treated mice following 12 weeks of treatment (magnification, ×400). ZO-1 was localized to the superficial umbrella cell layer at the apicolateral junction in the majority of control group samples (Fig. 3A); however, in the ketamine treatment groups, bladders exhibited a heterogeneous staining distribution, indicating that ZO-1 was distributed in the cytoplasm and was not absent or organized into tight junction structures (Fig. 3B). Additionally, the number of samples exhibiting abnormal ZO-1 distribution in the ketamine-treated group was increased compared with control group, with abnormal ZO-1 distribution in 70 vs. 0% (P=0.003) following 4 weeks, 70 vs. 10% (P=0.022) following 8 weeks and 90 vs. 10% (P=0.001) following 12 weeks of treatment in the ketamine-treated and control groups, respectively (Table I). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g02.jpg Figure 3. Representative immunohistochemical images of ZO-1 protein. For immunohistochemical analysis, tissue sections were incubated with primary antibody anti-ZO-1 overnight at 4°C. (A) In control mice, ZO-1 was localized to superficial umbrella cell layer at the interendothelial junctions in most samples. (B) In the ketamine group, ZO-1 located in the cytoplasm and not organized into tight junction structures, or absent. Magnification, ×200; scale bar, 100 µm. ZO-1, zonula occludens-1. Table I. Distribution of ZO-1 protein in each group. Treatment duration (weeks) ZO-1 distribution Ketamine (%) Control (%) P-valuea 4 0.003 Normal 3 (30) 10 (100) Abnormal 7 (70) 0 (0) 8 0.022 Normal 3 (30) 9 (90) Abnormal 7 (70) 1 (10) 12 0.001 Normal 1 (10) 9 (90) Abnormal 9 (90) 1 (10) Open in a separate window aFisher's exact test. ZO-1, zona occludens-1. Ultrastructure of bladder samples Morphological ultrastructural alterations to the uroepithelium and lamina propria of bladder cells were determined using TEM. As demonstrated in Fig. 4A-D, the surface of the umbrella cells in the control group were suffused with raised microplicae (indicated by arrows in Fig. 4A and B) and the cytoplasm of these cells contained multiple subapical vesicles (indicated with asterisks in Fig. 4B). Marked changes in bladder morphology were observed in the ketamine-treated group compared with the control group. The surface of the umbrella cells appeared more flattened following 4 (Fig. 4E-H) and 8 weeks (Fig. 4I-L), and even diminished following 12 weeks (Fig. 4M-P), of treatment in the ketamine-treated group compared with the control group. Thin tight junction complexes were frequently observed between the umbrella cells following 4 weeks of treatment in the ketamine-treated group (Fig. 4G); however, these distinct junction complexes were not observed following 8 and 12 weeks of ketamine treatment (Fig. 4K and O). In addition, the vascular endothelial cells exhibited cell body shrinkage, increased cytoplasm density and chromatin condensation following 8 weeks (Fig. 4L) and layer denudation following 12 weeks (Fig. 4P) of ketamine treatment. <Query> ================== At week 8, what urological changes were observed in the experimental group of mice (injected with ketamine)? <Instructions> ================== Base your response only on the document provided. List them in bullet point format. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context".
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Base your response only on the document provided. List them in bullet point format. If you cannot answer using the context alone, say "I cannot determine the answer to that due to lack of context".
EVIDENCE:
**Changes to the bladder epithelial barrier are associated with ketamine-induced cystitis - Results ** Animals and ketamine administration A total of 60 8-week-old female C57BL/6 mice (weight, 19.08±1.29 g) were obtained from Renming Hospital of Wuhan University Laboratory Animal Center (Wuhan, China). Mice were maintained under a 12-h light/dark cycle at a constant temperature (21–22°C) and humidity (50%). Mice had free access to food and tap water prior to the experiments. Mice were randomly allocated into two groups, control group and ketamine treatment group, and the mice in each group were subsequently subdivided into three subgroups (4, 8 and 12 week groups; n=10 mice/subgroup). Mice received daily intraperitoneal injections of saline (control group) or 100 mg/kg ketamine (Gutian Fuxing Pharmaceutical Co., Ltd., Gutian, China) (ketamine treatment group) to model the effects of repeated ketamine abuse, which was previously described in a study by Meng et al (15). Micturition behavior Micturition frequency was determined as previously described in a study by Gu et al (10). In brief, short-term micturition frequency of freely moving mice was observed at the end of 4, 8 and 12 weeks of treatment. At the end of the 4, 8 and 12 weeks, respectively, mice were placed in five separate square lattices containing a gridded filter paper pad, with each small grid containing a mouse. Filter paper was impregnated with saturated copper sulfate solution (CuSO4 5H2O) and dehydrated at 200°C for 1 h prior to use. When urine fell onto this filter paper, the anhydrous CuSO4 was rehydrated and turned blue. Subsequent to 2 h, the numbers of urine spots >0.2 cm in diameter were counted and recorded by five people independently with ultraviolet illumination. Histopathological and immunohistochemical analysis Mice were sacrificed with an intraperitoneal injection of sodium pentobarbital (100 mg/kg, Sigma-Aldrich; Merck KGaA, Germany) and bladders were excised for analyses. For histopathlogical analysis, half of the bladder tissues were fixed in 4% phosphate-buffered paraformaldehyde overnight at room temperature, dehydrated in serial ethanol concentrations, cleared in xylene and embedded into paraffin wax. Serial paraffin sections of 5 µm in thickness were created, stained with haematoxylin and eosin and subsequently examined under a light microscope (Nikon Corp., Tokyo, Japan). For immunohistochemical analysis, tissue sections were dewaxed and rehydrated with graded xylene and serial ethanol concentrations. Subsequently, immunohistochemical labeling for zonula occludens-1 (ZO-1) was performed. Following the blocking of nonspecific antibody activity using Tris-buffered saline (Sigma-Aldrich; Merck KGaA) containing 1% bovine serum albumin and 10% fetal calf serum at 37°C for 2 h, the tissue sections were incubated with primary antibody anti-ZO-1 (BSA-1543, 1:100 dilution; BioGenex, San Ramon, CA, USA) overnight at 4°C. Subsequently, hydrogen peroxide was used to eliminate the endogenous peroxidase activity at 37°C for 10 min. The distribution of ZO-1 marker was scored into two levels by two independent histologists: Normal and abnormal. If normal, the ZO-1 marker was distributed throughout the urothelium and more intensely under the umbrella cell layer with minimal expression in the cytoplasm. If abnormal, the distribution of the ZO-1 marker was patchy, absent, or expressed in the cytoplasm and not localized on cell surfaces. Ultrastructure of bladder samples For ultrastructure analysis, half of the bladder tissue samples from each mouse were fixed in 2.5% glutaraldehyde buffered in 0.1 M phosphate buffer, post-fixed in buffered 1% osmium tetroxide, dehydrated using ascending grades of ethanol and dry acetone, embedded in epoxy resin, and finally left in a resin-polymerizing oven overnight at 65°C. The protocol for ultrastructure analysis was in accordance with the method published in the study by Jeong et al (16) with some modifications. Ultrathin sections of 70 nm in thickness were created, mounted on 200-mesh hexagonal copper grids and stained with lead citrate. The ultrastructural urothelium of the bladder samples was observed using a Hitachi H-600 transmission electron microscope (TEM; Hitachi, Ltd., Tokyo, Japan). Statistical analysis Data are expressed as the mean ± standard error of the mean. Statistical analyses were performed using Prism v.5.0 software (GraphPad Software, Inc., La Jolla, CA, USA). Independent-samples t-tests were used to detect significant differences in micturition frequency between two groups. Fisher's exact test was used to measure any significant differences in ZO-1 expression. P<0.05 was considered to indicate a statistically significant difference. Go to: Results Micturition behavior As exhibited in Fig. 1, the micturition frequency in the ketamine-treated and control groups were determined as 8.05+1.799 and 8.36+1.492 following 4 weeks of treatment, and there was no significant difference in micturition frequency between the two groups at this time point (P>0.05). However, following 8 weeks of treatment, the micturition frequency in the ketamine-treated group was determined as 11.90+3.348 and was significantly increased compared with that of the control group (8.50+1.581; P<0.01). Similar results were obtained for the micturition frequency in the ketamine-treated group (15.30+4.423) following 12 weeks of treatment, and this was significantly higher than that of the control group (8.50+1.581; P=0.001). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g00.jpg Figure 1. Micturition frequency of freely moving mice measured in a 2-h time period. Data are presented as the mean ± standard error of the mean. **P<0.05 and ***P<0.01. Bladder pathology and immunohistochemistry The urinary bladders of the ketamine-treated mice displayed some pathology differences when compared with the controls. When compared with the control group (Fig. 2A), there was no significant inflammatory cell infiltration and arterial dilatation following 4 weeks of ketamine treatment (Fig. 2B); however, arterial dilatation and congestion were observed under the submucosal epithelium of the urinary bladder following 8 weeks of ketamine treatment (indicated by arrows; Fig. 2C). In addition to the above symptoms, inflammatory cells, predominantly lymphocytes and occasionally macrophages, had infiltrated into the submucosal epithelium of the urinary bladders of mice in the ketamine-treated group after 12 weeks of treatment (indicated by arrows; Fig. 2D). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g01.jpg Figure 2. Haematoxylin and eosin staining of midsagittal sections of murine bladders. Bladder sections from (A) the control group (magnification, ×400), (B) ketamine-treated mice following 4 weeks of treatment (magnification, ×400), (C) ketamine-treated mice following 8 weeks of treatment (magnification, ×200) and (D) ketamine-treated mice following 12 weeks of treatment (magnification, ×400). ZO-1 was localized to the superficial umbrella cell layer at the apicolateral junction in the majority of control group samples (Fig. 3A); however, in the ketamine treatment groups, bladders exhibited a heterogeneous staining distribution, indicating that ZO-1 was distributed in the cytoplasm and was not absent or organized into tight junction structures (Fig. 3B). Additionally, the number of samples exhibiting abnormal ZO-1 distribution in the ketamine-treated group was increased compared with control group, with abnormal ZO-1 distribution in 70 vs. 0% (P=0.003) following 4 weeks, 70 vs. 10% (P=0.022) following 8 weeks and 90 vs. 10% (P=0.001) following 12 weeks of treatment in the ketamine-treated and control groups, respectively (Table I). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g02.jpg Figure 3. Representative immunohistochemical images of ZO-1 protein. For immunohistochemical analysis, tissue sections were incubated with primary antibody anti-ZO-1 overnight at 4°C. (A) In control mice, ZO-1 was localized to superficial umbrella cell layer at the interendothelial junctions in most samples. (B) In the ketamine group, ZO-1 located in the cytoplasm and not organized into tight junction structures, or absent. Magnification, ×200; scale bar, 100 µm. ZO-1, zonula occludens-1. Table I. Distribution of ZO-1 protein in each group. Treatment duration (weeks) ZO-1 distribution Ketamine (%) Control (%) P-valuea 4 0.003 Normal 3 (30) 10 (100) Abnormal 7 (70) 0 (0) 8 0.022 Normal 3 (30) 9 (90) Abnormal 7 (70) 1 (10) 12 0.001 Normal 1 (10) 9 (90) Abnormal 9 (90) 1 (10) Open in a separate window aFisher's exact test. ZO-1, zona occludens-1. Ultrastructure of bladder samples Morphological ultrastructural alterations to the uroepithelium and lamina propria of bladder cells were determined using TEM. As demonstrated in Fig. 4A-D, the surface of the umbrella cells in the control group were suffused with raised microplicae (indicated by arrows in Fig. 4A and B) and the cytoplasm of these cells contained multiple subapical vesicles (indicated with asterisks in Fig. 4B). Marked changes in bladder morphology were observed in the ketamine-treated group compared with the control group. The surface of the umbrella cells appeared more flattened following 4 (Fig. 4E-H) and 8 weeks (Fig. 4I-L), and even diminished following 12 weeks (Fig. 4M-P), of treatment in the ketamine-treated group compared with the control group. Thin tight junction complexes were frequently observed between the umbrella cells following 4 weeks of treatment in the ketamine-treated group (Fig. 4G); however, these distinct junction complexes were not observed following 8 and 12 weeks of ketamine treatment (Fig. 4K and O). In addition, the vascular endothelial cells exhibited cell body shrinkage, increased cytoplasm density and chromatin condensation following 8 weeks (Fig. 4L) and layer denudation following 12 weeks (Fig. 4P) of ketamine treatment.
USER:
At week 8, what urological changes were observed in the experimental group of mice (injected with ketamine)?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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Using only the information in the provided context give your answer in bullet points.
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What were all of the findings on the non-human test subjects?
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Because the brain is particularly vulnerable to oxidative stress, and anxiety disorders are characterized by a decrease in protective antioxidants as well as an increase in oxidative damage, treatments that protect against oxidative stress are desirable (54, 55). Multiple suggested mechanisms have been suggested to explain how oxidative stress plays a role in brain disorders. Oxidative stress can act as a trigger for these disorders and can also be a result of neuroinflammation, which has also been linked to brain-related disorders (56). Figure 3 shows how the components of ashwagandha can affect cell signaling pathways and the production of inflammatory mediators. Inflammation in peripheral tissues may directly play a role in increasing neuroinflammation and oxidative stress in the brain (56). Although there is evidence linking both oxidative stress and inflammation to brain-related disorders, it has not been conclusively proven which one causes the other or vice versa (57). Studies on animals exploring the effects of WS on anxiety have revealed a strong link between improvements in anxiety-related behavior and the amelioration of oxidative stress and inflammatory indicators. The root extract and leaf extract of WS, although not clearly described, were able to increase the levels of catalase activity and reduced glutathione (GSH) in the brain, and also lower the levels of lipid peroxidation in a mouse model of sleep deprivation and a zebrafish model of neurotoxicity induced by benzo[a]pyrene (58, 59). Furthermore, WS demonstrated the ability to decrease nitrite levels in the mouse model and also lower protein carbonylation in the zebrafish model (58, 59). In an experiment using rats to simulate an ischemic stroke, a uniform hydroalcoholic extract derived from WS roots effectively decreased the levels of lipid peroxidation and enhanced antioxidant function in the brain (60). ASH-WEX, an aqueous leaf extract, was shown to decrease pro-inflammatory cytokines, specifically TNFα and IL-6, both in the peripheral and central nervous systems, in animal models of neuroinflammation and sleep deprivation (61). ASH-WEX produced a significant reduction in indicators of reactive gliosis, such as GFAP, as well as neuroinflammation, such as NOX2, iNOS, and COX2. Furthermore, it successfully regulated various inflammatory pathways and reduced cellular death in the brain (62). In a rat experiment examining the effects of a high fat diet on obesity, the use of WS dry leaf powder significantly lessened the expression of pro-inflammatory cytokines both in the body and brain, decreased indicators of reactive gliosis and neuroinflammation, modulated the nuclear factor NF-kappa-B (NF-κB) pathway, and lowered cell death (63). Supplementation with ashwagandha has been shown to lower C-reactive protein (CRP) activity (64), one of the most important indicators of inflammation. Furthermore, other studies have shown that ashwagandha exerts a number of anti-inflammatory effects on chronic inflammation-mediated diseases (65), particularly rheumatoid arthritis (66), inflammatory bowel disorder (67), and systemic lupus erythematosus (68). These studies suggest that ashwagandha may be a useful tool for reducing the cytokine storm. Withanolides, particularly Withaferin A, are responsible for the majority of ashwagandha’s anti-inflammatory effects, according to several reports (69, 70). Ashwagandha may work by interacting with components of the proinflammatory cell signaling pathway, such as NF-κB, signaling kinases, HSP90, Nrf2, and the inflammasome complex, even though the mechanisms behind the anti-inflammatory effect of withanolides are not fully understood (71). Since the NF-κB transcription factor family is implicated in a number of chronic disorders caused by inflammation, individuals with high NF-κB levels may benefit from therapeutic targeting of NF-κB. In this situation, ashwagandha has the ability to inhibit and mediate the activity of the NF-κB pathway (72). It is thought that strong protein kinase inhibitor activity is necessary for ashwagandha to function. Ashwagandha has the ability to inhibit the signaling cascades of protein kinases, which are essential in inflammatory pathways (72). Furthermore, it appears that kinase inhibition takes place when nitric oxide synthesis is inhibited, which also benefits the inflammatory process. Another possible explanation for ashwagandha’s anti-inflammatory properties is the downregulation or destabilization of HSP activity, which is implicated in regulatory kinase pathways. As previously mentioned, ashwagandha regulates Nrf2 to moderate oxidative stress (34, 73). Nrf2 activation may account for ashwagandha’s anti-inflammatory properties, as oxidative stress frequently takes place in sites of inflammation and is thought to be one cause of chronic inflammation (74). Finally, by blocking inflammasomes, cytokines, and other multiprotein pro-inflammatory complexes, ashwagandha may lessen inflammation (7 According to some reports, ashwagandha is an adaptogen that, due to its antioxidant properties, boosts immunity, helps the body respond to stress more effectively, increases resilience, and fights oxidative stress and cellular damage (76, 77). It has been demonstrated that the bioactive C28-steroidal lactones present in WS leaves possess neuroprotective, anxiolytic, antioxidant, and anti-inflammatory properties. Moreover, Withanoside IV and its metabolite sominone, found in WS roots, have been shown to promote synaptogenesis and neuronal outgrowth. Furthermore, it has been demonstrated that the herb inhibits acetylcholinesterase and protects rats from cognitive decline (78). One study evaluated the effects of ashwagandha root extract 300 mg twice a day in humans with moderate cognitive impairment (79). After 8 weeks, the treatment group outperformed the placebo group in tests measuring immediate and general memory, information-processing speed, executive function, and attention. However, the benefits on working memory and visuospatial processing were not definitive because there was little difference between the two groups’ performance on these tasks. Another study examined the effect of ashwagandha extract on cognitive impairment in individuals with bipolar disorder (80). Tests were conducted at baseline and after the intervention, with rats randomly allocated to receive 500 mg/day of ashwagandha or a placebo for 8 weeks. When compared to the placebo, subjects in the treatment group showed significantly better results on the Flanker Test (neutral mean reaction time), the Penn Emotional Acuity Test (mean social cognition response rating), and the Auditory Digit Span (mean digit span backward). These findings suggested that ashwagandha extract may safely enhance cognitive function in bipolar disorder patients, including verbal working memory, response time, and social cognition response. Another study was carried out using ashwagandha root extract on a group of horses. The animals were subjected to a variety of stressors, including loud noises, prolonged physical activity, and separation. Following a 21-day period, the treated group showed a statistically significant reduction in cortisol, glucose, adrenaline, IL-6, lipids, creatinine, aspartate aminotransferase, and alanine aminotransferase (81).
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system instruction: [Using only the information in the provided context give your answer in bullet points.] question: [What were all of the findings on the non-human test subjects?] context block: [Because the brain is particularly vulnerable to oxidative stress, and anxiety disorders are characterized by a decrease in protective antioxidants as well as an increase in oxidative damage, treatments that protect against oxidative stress are desirable (54, 55). Multiple suggested mechanisms have been suggested to explain how oxidative stress plays a role in brain disorders. Oxidative stress can act as a trigger for these disorders and can also be a result of neuroinflammation, which has also been linked to brain-related disorders (56). Figure 3 shows how the components of ashwagandha can affect cell signaling pathways and the production of inflammatory mediators. Inflammation in peripheral tissues may directly play a role in increasing neuroinflammation and oxidative stress in the brain (56). Although there is evidence linking both oxidative stress and inflammation to brain-related disorders, it has not been conclusively proven which one causes the other or vice versa (57). Studies on animals exploring the effects of WS on anxiety have revealed a strong link between improvements in anxiety-related behavior and the amelioration of oxidative stress and inflammatory indicators. The root extract and leaf extract of WS, although not clearly described, were able to increase the levels of catalase activity and reduced glutathione (GSH) in the brain, and also lower the levels of lipid peroxidation in a mouse model of sleep deprivation and a zebrafish model of neurotoxicity induced by benzo[a]pyrene (58, 59). Furthermore, WS demonstrated the ability to decrease nitrite levels in the mouse model and also lower protein carbonylation in the zebrafish model (58, 59). In an experiment using rats to simulate an ischemic stroke, a uniform hydroalcoholic extract derived from WS roots effectively decreased the levels of lipid peroxidation and enhanced antioxidant function in the brain (60). ASH-WEX, an aqueous leaf extract, was shown to decrease pro-inflammatory cytokines, specifically TNFα and IL-6, both in the peripheral and central nervous systems, in animal models of neuroinflammation and sleep deprivation (61). ASH-WEX produced a significant reduction in indicators of reactive gliosis, such as GFAP, as well as neuroinflammation, such as NOX2, iNOS, and COX2. Furthermore, it successfully regulated various inflammatory pathways and reduced cellular death in the brain (62). In a rat experiment examining the effects of a high fat diet on obesity, the use of WS dry leaf powder significantly lessened the expression of pro-inflammatory cytokines both in the body and brain, decreased indicators of reactive gliosis and neuroinflammation, modulated the nuclear factor NF-kappa-B (NF-κB) pathway, and lowered cell death (63). Supplementation with ashwagandha has been shown to lower C-reactive protein (CRP) activity (64), one of the most important indicators of inflammation. Furthermore, other studies have shown that ashwagandha exerts a number of anti-inflammatory effects on chronic inflammation-mediated diseases (65), particularly rheumatoid arthritis (66), inflammatory bowel disorder (67), and systemic lupus erythematosus (68). These studies suggest that ashwagandha may be a useful tool for reducing the cytokine storm. Withanolides, particularly Withaferin A, are responsible for the majority of ashwagandha’s anti-inflammatory effects, according to several reports (69, 70). Ashwagandha may work by interacting with components of the proinflammatory cell signaling pathway, such as NF-κB, signaling kinases, HSP90, Nrf2, and the inflammasome complex, even though the mechanisms behind the anti-inflammatory effect of withanolides are not fully understood (71). Since the NF-κB transcription factor family is implicated in a number of chronic disorders caused by inflammation, individuals with high NF-κB levels may benefit from therapeutic targeting of NF-κB. In this situation, ashwagandha has the ability to inhibit and mediate the activity of the NF-κB pathway (72). It is thought that strong protein kinase inhibitor activity is necessary for ashwagandha to function. Ashwagandha has the ability to inhibit the signaling cascades of protein kinases, which are essential in inflammatory pathways (72). Furthermore, it appears that kinase inhibition takes place when nitric oxide synthesis is inhibited, which also benefits the inflammatory process. Another possible explanation for ashwagandha’s anti-inflammatory properties is the downregulation or destabilization of HSP activity, which is implicated in regulatory kinase pathways. As previously mentioned, ashwagandha regulates Nrf2 to moderate oxidative stress (34, 73). Nrf2 activation may account for ashwagandha’s anti-inflammatory properties, as oxidative stress frequently takes place in sites of inflammation and is thought to be one cause of chronic inflammation (74). Finally, by blocking inflammasomes, cytokines, and other multiprotein pro-inflammatory complexes, ashwagandha may lessen inflammation (7 According to some reports, ashwagandha is an adaptogen that, due to its antioxidant properties, boosts immunity, helps the body respond to stress more effectively, increases resilience, and fights oxidative stress and cellular damage (76, 77). It has been demonstrated that the bioactive C28-steroidal lactones present in WS leaves possess neuroprotective, anxiolytic, antioxidant, and anti-inflammatory properties. Moreover, Withanoside IV and its metabolite sominone, found in WS roots, have been shown to promote synaptogenesis and neuronal outgrowth. Furthermore, it has been demonstrated that the herb inhibits acetylcholinesterase and protects rats from cognitive decline (78). One study evaluated the effects of ashwagandha root extract 300 mg twice a day in humans with moderate cognitive impairment (79). After 8 weeks, the treatment group outperformed the placebo group in tests measuring immediate and general memory, information-processing speed, executive function, and attention. However, the benefits on working memory and visuospatial processing were not definitive because there was little difference between the two groups’ performance on these tasks. Another study examined the effect of ashwagandha extract on cognitive impairment in individuals with bipolar disorder (80). Tests were conducted at baseline and after the intervention, with rats randomly allocated to receive 500 mg/day of ashwagandha or a placebo for 8 weeks. When compared to the placebo, subjects in the treatment group showed significantly better results on the Flanker Test (neutral mean reaction time), the Penn Emotional Acuity Test (mean social cognition response rating), and the Auditory Digit Span (mean digit span backward). These findings suggested that ashwagandha extract may safely enhance cognitive function in bipolar disorder patients, including verbal working memory, response time, and social cognition response. Another study was carried out using ashwagandha root extract on a group of horses. The animals were subjected to a variety of stressors, including loud noises, prolonged physical activity, and separation. Following a 21-day period, the treated group showed a statistically significant reduction in cortisol, glucose, adrenaline, IL-6, lipids, creatinine, aspartate aminotransferase, and alanine aminotransferase (81).]
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Using only the information in the provided context give your answer in bullet points.
EVIDENCE:
Because the brain is particularly vulnerable to oxidative stress, and anxiety disorders are characterized by a decrease in protective antioxidants as well as an increase in oxidative damage, treatments that protect against oxidative stress are desirable (54, 55). Multiple suggested mechanisms have been suggested to explain how oxidative stress plays a role in brain disorders. Oxidative stress can act as a trigger for these disorders and can also be a result of neuroinflammation, which has also been linked to brain-related disorders (56). Figure 3 shows how the components of ashwagandha can affect cell signaling pathways and the production of inflammatory mediators. Inflammation in peripheral tissues may directly play a role in increasing neuroinflammation and oxidative stress in the brain (56). Although there is evidence linking both oxidative stress and inflammation to brain-related disorders, it has not been conclusively proven which one causes the other or vice versa (57). Studies on animals exploring the effects of WS on anxiety have revealed a strong link between improvements in anxiety-related behavior and the amelioration of oxidative stress and inflammatory indicators. The root extract and leaf extract of WS, although not clearly described, were able to increase the levels of catalase activity and reduced glutathione (GSH) in the brain, and also lower the levels of lipid peroxidation in a mouse model of sleep deprivation and a zebrafish model of neurotoxicity induced by benzo[a]pyrene (58, 59). Furthermore, WS demonstrated the ability to decrease nitrite levels in the mouse model and also lower protein carbonylation in the zebrafish model (58, 59). In an experiment using rats to simulate an ischemic stroke, a uniform hydroalcoholic extract derived from WS roots effectively decreased the levels of lipid peroxidation and enhanced antioxidant function in the brain (60). ASH-WEX, an aqueous leaf extract, was shown to decrease pro-inflammatory cytokines, specifically TNFα and IL-6, both in the peripheral and central nervous systems, in animal models of neuroinflammation and sleep deprivation (61). ASH-WEX produced a significant reduction in indicators of reactive gliosis, such as GFAP, as well as neuroinflammation, such as NOX2, iNOS, and COX2. Furthermore, it successfully regulated various inflammatory pathways and reduced cellular death in the brain (62). In a rat experiment examining the effects of a high fat diet on obesity, the use of WS dry leaf powder significantly lessened the expression of pro-inflammatory cytokines both in the body and brain, decreased indicators of reactive gliosis and neuroinflammation, modulated the nuclear factor NF-kappa-B (NF-κB) pathway, and lowered cell death (63). Supplementation with ashwagandha has been shown to lower C-reactive protein (CRP) activity (64), one of the most important indicators of inflammation. Furthermore, other studies have shown that ashwagandha exerts a number of anti-inflammatory effects on chronic inflammation-mediated diseases (65), particularly rheumatoid arthritis (66), inflammatory bowel disorder (67), and systemic lupus erythematosus (68). These studies suggest that ashwagandha may be a useful tool for reducing the cytokine storm. Withanolides, particularly Withaferin A, are responsible for the majority of ashwagandha’s anti-inflammatory effects, according to several reports (69, 70). Ashwagandha may work by interacting with components of the proinflammatory cell signaling pathway, such as NF-κB, signaling kinases, HSP90, Nrf2, and the inflammasome complex, even though the mechanisms behind the anti-inflammatory effect of withanolides are not fully understood (71). Since the NF-κB transcription factor family is implicated in a number of chronic disorders caused by inflammation, individuals with high NF-κB levels may benefit from therapeutic targeting of NF-κB. In this situation, ashwagandha has the ability to inhibit and mediate the activity of the NF-κB pathway (72). It is thought that strong protein kinase inhibitor activity is necessary for ashwagandha to function. Ashwagandha has the ability to inhibit the signaling cascades of protein kinases, which are essential in inflammatory pathways (72). Furthermore, it appears that kinase inhibition takes place when nitric oxide synthesis is inhibited, which also benefits the inflammatory process. Another possible explanation for ashwagandha’s anti-inflammatory properties is the downregulation or destabilization of HSP activity, which is implicated in regulatory kinase pathways. As previously mentioned, ashwagandha regulates Nrf2 to moderate oxidative stress (34, 73). Nrf2 activation may account for ashwagandha’s anti-inflammatory properties, as oxidative stress frequently takes place in sites of inflammation and is thought to be one cause of chronic inflammation (74). Finally, by blocking inflammasomes, cytokines, and other multiprotein pro-inflammatory complexes, ashwagandha may lessen inflammation (7 According to some reports, ashwagandha is an adaptogen that, due to its antioxidant properties, boosts immunity, helps the body respond to stress more effectively, increases resilience, and fights oxidative stress and cellular damage (76, 77). It has been demonstrated that the bioactive C28-steroidal lactones present in WS leaves possess neuroprotective, anxiolytic, antioxidant, and anti-inflammatory properties. Moreover, Withanoside IV and its metabolite sominone, found in WS roots, have been shown to promote synaptogenesis and neuronal outgrowth. Furthermore, it has been demonstrated that the herb inhibits acetylcholinesterase and protects rats from cognitive decline (78). One study evaluated the effects of ashwagandha root extract 300 mg twice a day in humans with moderate cognitive impairment (79). After 8 weeks, the treatment group outperformed the placebo group in tests measuring immediate and general memory, information-processing speed, executive function, and attention. However, the benefits on working memory and visuospatial processing were not definitive because there was little difference between the two groups’ performance on these tasks. Another study examined the effect of ashwagandha extract on cognitive impairment in individuals with bipolar disorder (80). Tests were conducted at baseline and after the intervention, with rats randomly allocated to receive 500 mg/day of ashwagandha or a placebo for 8 weeks. When compared to the placebo, subjects in the treatment group showed significantly better results on the Flanker Test (neutral mean reaction time), the Penn Emotional Acuity Test (mean social cognition response rating), and the Auditory Digit Span (mean digit span backward). These findings suggested that ashwagandha extract may safely enhance cognitive function in bipolar disorder patients, including verbal working memory, response time, and social cognition response. Another study was carried out using ashwagandha root extract on a group of horses. The animals were subjected to a variety of stressors, including loud noises, prolonged physical activity, and separation. Following a 21-day period, the treated group showed a statistically significant reduction in cortisol, glucose, adrenaline, IL-6, lipids, creatinine, aspartate aminotransferase, and alanine aminotransferase (81).
USER:
What were all of the findings on the non-human test subjects?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 14 | 11 | 1,040 | null | 643 |
Please do not use any other resources to answer the question other than the information I provide you. If you cannot answer with only the information I provide say "I cannot answer without further research."
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What are the key considerations and strategies for people who use stimulant drugs and engage in concurrent sex in terms of HIV prevention, and how does the effectiveness of these strategies get optimized?
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Purpose of this guide The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses. It aims to: • Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations • Provide implementation guidance to help establish and expand access to core HIV and hepatitis prevention, treatment, care and support services It is a global document that should be adapted according to the specific context, including the type of stimulant drug used (cocaine, ATS or NPS) and the key populations involved, which vary considerably according to regions. The present guide proposes a package of core interventions adapted from existing international guidance: • WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users[7] • WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations – 2016 update [8] • Implementing comprehensive HIV and HCV programmes with people who inject drugs: practical guidance for collaborative interventions (the “IDUIT”) [9] It also incorporates guidance from the implementation tools for other key populations: • Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions (the “SWIT”) [10] • Implementing comprehensive HIV and STI programmes with men who have sex with men: practical guidance for collaborative interventions (the “MSMIT”) [11] • Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions (the “TRANSIT”) [12] However, none of these guidance documents and tools addresses the specific needs of people who use stimulant drugs and are at risk for HIV and hepatitis B and C – hence the need for this publication. Audience The guide is intended for use by policymakers, programme managers and service providers, including community-based organizations, at the national, regional or local levels, who undertake to address HIV prevention, treatment and care. It also provides useful information for development and funding agencies and for academia. Structure The guide is divided into five chapters. • Chapter 1 explains the nature and effects of stimulant drugs, the associated risks of HIV and hepatitis transmission, and the issues surrounding stimulant drug use and HIV and hepatitis risk in specific key populations and other vulnerable groups. 10 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Chapter 2 presents the package of core HIV interventions for key populations who use stimulant drugs. • Chapter 3 describes approaches to care and support for people who use stimulant drugs, particularly in the context of HIV and hepatitis. • Chapter 4 describes six critical enablers – activities and strategies that are needed to ensure access to the interventions in the core package. • Chapter 5 outlines further considerations for implementing programmes. Within each chapter, further resources are listed. Case studies are provided throughout the guide to illustrate specific aspects of programmes that have been implemented in different countries. There is also an annex presenting a series of checklists and other practical tools for policymakers and implementers. Principles Two important overarching principles are stressed throughout this publication. The first is better integration of HIV, hepatitis B and C and sexually transmitted infection (STI) services for people who use stimulant drugs within existing HIV harm reduction services2 and drug treatment services for people who inject drugs, and within sexual and reproductive health and other HIV services for key populations. The second is the meaningful involvement of people who use stimulant drugs, people living with HIV and other key populations in planning, implementing, monitoring and evaluating interventions. This is key to their success and sustainability. Finally, the implementation of HIV-related services for people who use stimulant drugs should adhere to human-rights principles as described in the implementation tools mentioned above – the SWIT, MSMIT, TRANSIT and IDUIT. Methodology In its June 2009 session, the UNAIDS Programme Coordinating Board (PCB) called upon “Member States, civil society organizations and UNAIDS to increase attention on certain groups of non-injecting drug users, especially those who use crack cocaine and ATS, who have been found to have increased risk of contracting HIV through high-risk sexual practices”. UNODC therefore commissioned a review and organized a Global Expert Group Technical Meeting on Stimulant Drugs and HIV, held in Brazil in 2010. A discussion paper on HIV prevention, treatment and care among people who use (noninjecting) crack and cocaine or other stimulant drugs, particularly ATS, was developed in 2012. In 2013 the UNODC HIV Civil Society Organization (CSO) group established a Stimulant Drugs and HIV working group, with representatives from civil society and experts on HIV and stimulant drugs. The group organized consultations with representatives of the community and CSOs, including on the margins of the International Harm Reduction Conference in Kuala Lumpur in 2015. 2 For the purposes of this guide, harm reduction is defined by the nine interventions of the “comprehensive package” of services detailed in the WHO, UNODC, UNAIDS Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (see citation 7). These are: 1. Needle and syringe programmes; 2. Opioid substitution therapy and other drug dependence treatment; 3. HIV testing and counselling; 4. Antiretroviral therapy; 5. Prevention and treatment of sexually transmitted infections; 6. Condom programmes for people who inject drugs and their sexual partners; 7. Targeted information, education and communication; 8. Prevention, vaccination, diagnosis and treatment for viral hepatitis; 9. Prevention, diagnosis and treatment of tuberculosis. 11 In December 2014, the Strategic Advisory Group to the United Nations on HIV and injecting drug use, consisting of representatives of networks and organizations of people who use drugs, academics, donors, implementers and United Nations organizations, recommended conducting a new literature review on stimulant drugs and HIV and hepatitis C. In 2015 UNODC, together with WHO and UNAIDS, defined the scope of this new literature review, and accordingly UNODC commissioned it to cover the extent, patterns and geographic distribution of injecting and non-injecting stimulant drug use (particularly crack, cocaine, ATS and stimulant NPS) in men who have sex with men, sex workers and other groups of stimulant drug users, and their possible link to HIV and hepatitis B and C vulnerability and transmission; and effective interventions for prevention, treatment and care of HIV and hepatitis B and C among people who use such stimulant drugs. The results of the literature review were published by UNODC in 2016 in five papers covering the following topics: • Methodology and summary [3] • ATS [13] • Cocaine and crack cocaine [14] • NPS [15] • Treatment and prevention of HIV, HCV & HBV among stimulant drug users[16]. Subsequently, in the framework of preparations for the United Nations General Assembly Special Session on the World Drug Problem (UNGASS 2016) and the HLM 2016, UNODC organized a scientific consultation on HIV and drug use, including stimulant drugs. The papers relating to stimulant drugs presented at the Commission on Narcotic Drugs in March 2016 covered: cocaine and crack cocaine use and HIV in the United States; ATS and men who have sex with men in Asia; and antiretroviral therapy (ART) and stimulant drug use. The recommendations of the contributing scientists were summarized as part of a scientific statement presented in New York on the margins of the UNGASS 2016 and the HLM 2016 [17]. The statement stressed the need to address HIV among people who use stimulant drugs, including the structural, social and personal mediating factors for HIV transmission, such as polydrug use, STIs, mental health, homophobia, discrimination and punitive laws. The scientists recommended the provision of ART to all people using stimulant drugs living with HIV, and the implementation of new prevention tools such as pre-exposure prophylaxis (PrEP) and the use of social media for communication. The statement also emphasizes that with proper support for adherence, ART is effective among people living with HIV who use stimulant drugs. In 2017, UNODC commissioned the development of the present publication, HIV prevention, treatment, care and support for people who use stimulant drugs: an implementation guide. Based on the results of the scientific reviews and of the expert group meetings, and on international guidance and country practices that have been identified as effective in meeting the needs of people who use stimulant drugs, a first draft of the document was developed under the guidance of the UNODC CSO Stimulant Drugs and HIV working group. The draft guide was reviewed by external peer reviewers, United Nations agency reviewers and community representatives through an electronic consultation and three face-to-face consultations held in Viet Nam (2017), Brazil (2017) and Ukraine (2018). Chapter 1 Stimulant drugs, HIV and hepatitis, and key populations The World Drug Report 2019 estimates that about 29 million people used ATS in 2017, and 18 million used cocaine [18]. There is no estimate of the total number of people using NPS. The great majority of people who use stimulant drugs do so on an occasional basis which may be characterized as “recreational”, and they will not develop dependence or any other health problem. There is evidence that the prevalence of ATS use, particularly methamphetamines, is increasing in some regions, including North America, Oceania and most parts of Asia. In addition, between 2009 and 2016, there were reports of 739 NPS, of which 36 per cent were classified as stimulant drugs [19]. Only a small proportion of people who use stimulant drugs inject them; most smoke, snort or use them orally or anally. However, the World Drug Report 2017 states that 30 per cent of people who inject drugs inject stimulant drugs, either as their drug of first choice or in addition to opiates. Despite evidence showing that certain subgroups of people who use stimulant drugs are at greater risk of HIV, prevention, testing and treatment programmes for these population groups remain very limited in scope and scale across the globe, and their specific needs are often overlooked. 1.1 Stimulant drugs Stimulant drugs are chemically diverse substances that are similar in their capacity to activate, increase or enhance the neural activity of the central nervous system, resulting in a common set of effects in most people who use them, including increased alertness, energy and/or euphoria.3 This publication considers three types of stimulant drugs for which data have shown a link with increased HIV risk among some key populations: • Cocaine: Found in various forms, e.g. smokable cocaine, crack cocaine, freebase, paste or pasta base, paco, basuco. Depending on the form, it may be sniffed or snorted, injected, ingested or inserted anally. 3 For more detailed information on different stimulant drugs and their effects, see: Terminology and information on drugs. Third edition. New York (NY), United Nations, 2016 (https://www.unodc.org/documents/scientific/Terminology_and_ Information_on_Drugs-3rd_edition.pdf, accessed 15 January 2019). 14 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Amphetamine-type stimulants: Amphetamines and methamphetamines (excluding MDMA) are found in different forms, e.g. crystals (methamphetamines), powder or formulated tablets [20]. They are taken orally, smoked from a pipe, sniffed or snorted, inserted anally or injected in a solution. • Stimulant new psychoactive substances: Found in various forms, e.g.synthetic cathinone, phenethylamines, aminoindanes and piperazines. They are sometimes referred to as “bath salts” [21][22]. Depending on the form, NPS are taken orally, smoked, inserted anally or injected. All types of stimulant drugs have common effects: • Mental: Euphoria, raised libido, reduced appetite and sleep drives, enhanced perception, increased alertness, cognitive improvements and deficits (attention, working memory, long-term memory), emotional intensity and excitability, and increased confidence. • Behavioural: Talkativeness, hypervigilance, hyperactivity, increased sociability, disinhibition, changes in sexual behaviour (including sexual sessions of longer than usual duration), faster reaction, and repetitive activity (“tweaking”); hyper-excitability, insomnia, restlessness, panic, erratic behaviour, and sometimes aggressive or violent behaviour[23]. • Physical: Increased heart rate (including palpitations), raised temperature (hyperthermia), circulatory changes (higher blood pressure, vasoconstriction), increased breathing rate, dry mouth, teeth-grinding, jaw-clenching/gurning, faster eye-movements, and dilated pupils. The onset and duration of these effects vary according to the drug, its form, dosage, route of administration, the characteristics of the individual using it, and the context of use. Chronic use of stimulant drugs can lead to psychological dependence; development of tolerance; destruction of tissues in the nose if snorted or sniffed; chronic bronchitis, which can lead to chronic obstructive pulmonary disease; malnutrition and weight loss; disorientation, apathy, confusion, exhaustion due to lack of sleep, and paranoid psychosis. During withdrawal there may be a long period of sleep and depression. Cocaine Cocaine is generally encountered in two forms which differ in their route of administration: cocaine hydrochloride (HCL), a powder, which is snorted, injected or taken anally, and cocaine base (crack, freebase, or crystal) which is smokable and usually taken in a pipe. A third form, coca paste (pasta base, paco, coca pasta, etc.), is an intermediate product of the process of extraction of HCL from the coca leaves. Available mainly in Latin America, it is usually smoked in a cigarette. Cocaine is a powerful stimulant whose effects diminish quickly, prompting the user to repeatedly administer additional doses. When snorted, cocaine produces a slow wave of euphoria, followed by a plateau and then a “come down” period. In its smokable form, cocaine has a more intense and immediate effect. Severe anticipatory anxiety about the impending low may result in repeat dosing. This cycle may take around 5 to 10 minutes. The use of cocaine is more prevalent in North and South America than in the rest of the world. Amphetamine-type stimulants (ATS) Amphetamine and methamphetamine are synthetic drugs whose effects include euphoria, arousal and psychomotor activation. ATS can be taken orally, intranasally, smoked as a vapour (pipe), inserted anally or injected. Immediately after smoking or injecting, people experience a pleasurable “rush”. Intranasal and oral ingestion produce a gradual euphoria or “come up”. Depending on the level of tolerance, the effects of methamphetamine may last four hours, or as long as 24 hours for someone new to the drug [24]. Some people who use methamphetamine may experience a feeling of invincibility, with an accompanying propensity to engage in high-risk behaviours, creating vulnerabilities to acquiring HIV [25]. The direct health impacts of ATS include insomnia and cardiovascular stress. Long-term negative effects may include dopamine physical dependence, psychological dependence, psychosis and paranoia, and depression. Amphetamine and methamphetamine use is reported in all parts of the world. Stimulant new psychoactive substances There are a various types of new psychoactive substances (NPS), with different molecular structures, but the majority of stimulant NPS are synthetic cathinones, which have a similar molecular structure to cathinone found in the khat plant. Common synthetic cathinones include mephedrone, pentedrone, methylone or methcathinone. They fall into two main families: euphoriants and entactogens.NPS are taken orally, can also be snorted or inserted anally, and less frequently are injected. Stimulant NPS produce similar mental, physical and behavioural effects to traditional stimulant drugs such as cocaine, amphetamines and methamphetamines. Synthetic cathinones and other stimulant NPS are also used to improve sexual experience [26]. The use of synthetic cathinone such as mephedrone (sometimes called “bath salts”) has recently emerged [18]. Studies from Hungary [27][28][29], Ireland [30][31], Israel [32], Romania [33] and the United Kingdom [34] suggest that due to a shortage in heroin supply and easy access to synthetic cathinone, a significant proportion of people who inject drugs have switched to injecting synthetic cathinone in recent years. 1.2 Stimulant drug use and risks of HIV/HBV/HCV transmission The HIV/HBV/HCV risk associated with stimulant drug use is linked to a higher prevalence of unprotected anal and vaginal sex, and of sharing pipes, straws and injection equipment, in some groups of men who have sex with men, sex workers, people who inject drugs and people in prisons. Transmission risks through concurrent stimulant drug use and unprotected sex Inconsistent condom use by people who use stimulant drugs has been identified as a prime means of contracting STIs, including HIV, particularly as a result of the concurrent use of stimulant drugs with frequent sexual activity of long duration with multiple partners or in groups. Stimulant drug use may also facilitate longer penetration (which can lead to condom breakages), and more intense acts such as fisting that increase the opportunity of anal and vaginal tears or bleeding. Transmission risks through sharing injection equipment Injecting methamphetamine, cocaine or NPS entails a similar risk to injecting other drugs when needles and injecting equipment are shared. Given that many stimulant drugs have a shorter duration of action compared with opioids, people who inject stimulant drugs report a higher frequency of injecting, with compulsive re-injecting and a greater likelihood of sharing and reusing needles and syringes that may be contaminated [22][34]. HIV and HCV risk is also increased when cocaine or crack is coadministered with heroin, including injection of heroin and cocaine (“speedballing”) [35]. Coexisting injecting drug use and unprotected sex further increases the likelihood of HIV and hepatitis transmission, especially in high-incidence communities. This pattern has been seen, for example, with the use of home-made ATS, such as boltushka in Ukraine. People who inject boltushka engage in high levels of injecting risk behaviours and in sexual risk behaviour post use. They are young and poor, and the great majority are already living with HIV [36]. Hepatitis C transmission through straws or pipes HCV is transmitted through blood or, less commonly, through sexual contact. HCV can be transmitted from a person living with hepatitis who has oral or nasal sores or lacerations through sharing of straws or pipes [37][38][39][40]. Compared with the general population, higher HCV prevalence rates, ranging from 2.3 to 17 per cent, have been observed among people who smoke or sniff stimulant drugs [41]. However, it is difficult to determine whether HCV transmission in these cases occurred through blood exposure, sexual activity, or both. 1.3 Stimulant drug use and HIV/HBV/HCV transmission risks among key populations Men who have sex with men There seems to be a clear association between ATS use among men who have sex with men and risk of HIV infection. Methamphetamine use has been associated with increased frequency of unprotected sex among some men who have sex with men, thereby increasing vulnerability to STIs, HBV and HIV [42][43][44][45]. Studies have indicated HIV prevalence rates among men who have sex with men who use methamphetamine ranging between 17 and 61 per cent, and HIV incidence ranging from 2.71 per 100 person-years [46] to 5 per 100 person-years [47]. The use of stimulant drugs by some men who have sex with men to facilitate sex (referred to as ChemSex)4 has been linked to decreased condom use, sex with multiple partners and other high-risk sexual behaviours that increase likelihood of HIV and HCV transmission [48][49]. Increased sexual risk behaviours, including unprotected sex, coupled with potential anal or rectal trauma resulting from longer, more frequent and intense sexual encounters under the influence of drugs, could facilitate STI transmission among men who have sex with men, including HCV among men who have sex with men living with HIV. Risk-reduction strategies for HIV prevention such as serosorting5 and strategic positioning6 are inefficient for the prevention of other STIs, HBV or HCV. The association between ChemSex, drug use and sexually transmitted acute HCV infection among men living with HIV who have sex with men has been documented in several countries and regions [50]. ChemSex is mostly associated with non-injecting drug use, although some may also inject synthetic cathinones, amphetamines and methamphetamines (referred to as “slamming” or “blasting” within the context of ChemSex) [51], with a high level of sharing of injection equipment and consequently higher risks of HIV and HCV transmission [52][53][54]. Mephedrone use seems to have risen among men who have sex with men in the context of ChemSex [52]. The use of erectile dysfunction medications such as sildenafil is often reported among men who have sex with men who also consume methamphetamines and has been identified as increasing rates of unprotected sex and HBV, syphilis and HIV risks [46][48][55]. People who inject drugs Injecting stimulant drugs carries the greatest risk of acquiring HCV or HIV, due primarily to the sharing of contaminated needles and syringes. People who inject cocaine, ATS or heroin have a risk of acquiring HIV that is respectively 3.6, 3.0, and 2.8 times greater than people using stimulant drugs without injecting [56]. Outbreaks of HIV or hepatitis C among people who inject drugs, partly due to the increased use of synthetic cathinone as a replacement for heroin, have been reported in Greece [57], Hungary [29] and Romania [33][58]. People who inject stimulant drugs such as ATS show higher prevalence of sexual risk behaviours compared with people who inject opiates, and similar to non-injecting ATS users [59][60][61][62]. Sex workers Exchanging sex for crack cocaine or money has been associated with several HIV risk behaviours, such as having a greater number of clients per week [63], high levels of unprotected sex [64], sharing crack cocaine with clients [65] and heavier crack use, as well as structural vulnerabilities like homelessness and unemployment [66]. One study reported a higher HIV prevalence among those who exchange sex for drugs or money than among those who did not [67]. Individuals with drug dependencies who exchange sex for drugs may have reduced power and control over sexual interactions [68]. The use of methamphetamines by female sex workers has been associated with engaging in unsafe sex [69]. Female sex workers who use smokable cocaine are often homeless or poorly housed in economically depressed neighbourhoods, and have poor access to health services, including HIV services, as well as to prenatal and reproductive care and to social support. Sex workers, whether male, female or transgender, may be coerced into consuming drugs with their clients, increasing the risk of unprotected sex and violence. Male, female and transgender sex workers face barriers to accessing and using services due to the multiple stigma surrounding drug use, sex work and sexual orientation, which are criminalized to varying degrees in many jurisdictions around the world. Transgender people The use of methamphetamines, smokable cocaine or cocaine among transgender women has been associated with higher risks of HIV transmission, mainly through sex [70][71]. For example, a survey conducted among transgender women in high-risk venues and on the streets of Los Angeles, United States, indicated that recent methamphetamine and/or smokable cocaine use was associated with a more than twofold higher risk of reported HIV-positive status [72]. People living in prisons and other closed settings People who use stimulant drugs, such as methamphetamine, in prisons are more likely to engage in a number of sexual risk behaviours, including use of methamphetamines in the context of sex and inconsistent use of condoms [73][74]. 18 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Women who use drugs Women who use drugs face stigma and other barriers to accessing essential health and HIV services, including gender-based violence, fear of forced or coerced sterilization or abortion, or loss of child custody. Cross-cultural stigma associated with women vacating gender roles, such as caring for their family, being pregnant and being mothers of infants and children, is a major challenge [75]. Many women who use drugs face unequal power dynamics in relationships, and higher rates of poverty; these factors interfere with their ability to access reproductive health supplies, including condoms and other contraceptives [76]. People living with HIV Although cocaine or methamphetamine use has a negative impact on the immune system, particularly among people living with HIV, the immunodepressive effect disappears when people living with HIV who use stimulant drugs adhere to antiretroviral therapy [77]. People living with HIV using stimulant drugs experience the worst HIV outcomes when they do not know they are living with HIV, or cannot access ART. A review of the literature reports findings that psychological, behavioural and social factors all play a role, separately and in combination, in determining HIV outcomes in patients, their access to health services, and adherence to ART: • In people living with HIV, regular methamphetamine use has measurable negative effects upon neuropsychological functioning (e.g. deficits in episodic memory, executive functions and information-processing speed) [78] over and above the negative neurocognitive effects caused by HIV and HCV [79]. This may impact their health-protective behaviour, health-services-seeking, access to HIV clinics and adherence to ART. In addition, HIV-specific traumatic stress and related negative affect are independently associated with greater stimulant-drug risk behaviours and reduced ART adherence [80]. • Cocaine and ATS have a negative impact on the immune system, increasing vulnerability to opportunistic diseases and accelerating the evolution of HIV among people who do not adhere to ART [77][81]. (See section 2.4 for more information on the interactions between ART and stimulant drugs). • Some communities of people who use stimulant drugs are very marginalized, extremely poor and have few resources, including access to adequate nutrition, and this also impacts their access to services and consequently the evolution of HIV infection. To reach people who frequently use stimulant drugs and retain them in effective HIV treatment regimes, access and adherence barriers related to HIV treatment must be accurately identified and addressed. When assessing why a patient who uses stimulant drugs is lost to follow-up, important factors that should be considered include stigma, discrimination, mental health, employment status, poverty, homelessness, migration, exposure to violence, incarceration, fear of criminalization, and family responsibilities. See chapter 4 for more information. 1.4 The impact of criminal sanctions on HIV transmission among key populations Stigma, discrimination and criminal sanctions against people who use drugs, men who have sex with men, transgender people, sex workers and people living with HIV have a direct impact on their ability and willingness to access and use HIV and other health services. These also impede the ability of people from key populations to access the commodities or services needed to practise protective behaviours, including condom use, and to access sterile injecting equipment, HIV testing and HIV treatment. A systematic review of 106 peer-reviewed studies published between 2006 and 2014 examined the association between criminal sanctions for drug use and HIV prevention and treatment-related outcomes among people who inject drugs [82]. While the studies were mainly conducted in North America and Asia, the findings highlighted that criminal sanctions were responsible for substantial barriers to HIV treatment and prevention interventions for people who inject drugs. 21 Chapter 2 Core interventions Following an extensive literature review and technical consultations at country and global levels, expert participants in a number of consultations agreed on a package of eight core interventions for HIV prevention, treatment, care and support among people who use stimulant drugs and are at risk of HIV. These interventions have been adapted from the WHO/UNODC/UNAIDS Comprehensive Package for HIV and people who inject drugs, and from the WHO Consolidated Package for HIV and key populations [7][8]. 1 Condoms, lubricants and safer sex programmes 2 Needle and syringe programmes (NSP) and other commodities 3 HIV testing services (HTS) 4 Antiretroviral therapy (ART) 5 Evidence-based psychosocial interventions and drug dependence treatments 6 Prevention, diagnosis and treatment of STIs, hepatitis and tuberculosis (TB) 7 Targeted information, education and communication (IEC) for people who use stimulant drugs and their sexual partners 8 Prevention and management of overdose and acute intoxication The core interventions should be adapted to the specific needs of different key populations. An assessment of the population to be served will assist in providing the evidence needed to design a clientcentred package of services that responds to specific needs. 2.1 Condoms, lubricants and safer sex programmes People who have sex while under the influence of stimulant drugs are more likely to engage in sexual risk behaviours, especially unprotected sex [83]. They may have reduced sexual inhibitions and a feeling of invincibility, which makes choosing or remembering to use a condom more challenging. Other factors that can contribute to inconsistent condom use include lack of access to condoms and lubricants when needed, poor safe-sex negotiations skills, being on PrEP [84] and engaging in risk-reduction strategies such as serosorting or strategic positioning. These strategies have their limits in terms of risk for HIV transmission, particularly if people are under the influence of stimulant drugs, and they do not prevent transmission of other STIs including HBV and HCV. Promoting the use of male and female condoms and appropriate lubricants remains a core HIV prevention strategy for people who use stimulant drugs and their sexual partners. Condoms offer protection against HIV, other STIs such as syphilis and gonorrhoea, and possible sexual transmission of HBV or HCV. Condoms can also prevent unintended pregnancy. Condoms and lubricants should be available widely, and without charge. Targeted distribution of free condoms helps overcome the barriers associated with their cost and can help reinforce the social acceptability of condom use. Distribution of condoms and sex-education information by peers and outreach workers plays an important role, including in the street or party setting. It is important to consider the variety of condoms available to meet key population preferences, and their distribution, to ensure wide availability of condoms and lubricant and access to them in places where people engage in stimulant drug use and sex concurrently. For example, in the case of sex-onpremises venues or nightclubs, simply making condoms available in the usual places, such as toilets or at the bar, is often not sufficient to ensure that people have them to hand when they need them. Consultation with the beneficiaries is critical to ensure easy access. Similarly, to ensure access to condoms in prisons, strategies must be tailored to each prison, based on its architecture, regime and the movements of prisoners within the prison. Safer-sex education for people who use stimulant drugs should cover: • Promotion of condoms and lubricant use • Information on sexual transmission of HIV, hepatitis and STIs • Safe-sex negotiation strategies • Information on strategies to reduce risks of HIV transmission (sero-sorting and strategic positioning), including their limitations • Information on pre-exposure prophylaxis of HIV (PrEP) Further resources The four key population implementation guides (the IDUIT, MSMIT, SWIT and TRANSIT) provide useful general information on condoms, lubricants and safer sex programming for people who inject drugs, men who have sex with men, sex workers and transgender people. 23 Chapter 2 Core interventions 2.2 Needle and syringe programmes and other commodities Due to the short duration of their effects, injection of stimulant drugs is frequently associated with rapidly repeated injecting, with some individuals reporting more than 20 injections a day. Injecting may take place in groups, and people may use several different stimulant drugs and other types of drug in the same session. These patterns of use increase the likelihood that non-sterile equipment will be used or shared, elevating the risk of HIV and hepatitis transmission. The accessibility and design of needle and syringe programmes (NSPs) must take into account the nature of stimulant drugs and patterns of their use. People who inject stimulant drugs should be educated, encouraged and supported to acquire sufficient sterile syringes. NSP policies and protocols should allow people who inject stimulant drugs access to enough injecting equipment for themselves and their peers. One-for-one exchange or other forms of restricted access to needles and syringes are not recommended in any situation and are particularly unhelpful with people who inject stimulant drugs [85][86]. In the party and club scene, injecting stimulant drugs is more likely to take place outside the normal operating hours of HIV harm reduction services. NSPs and other community drug services do not always engage with the party and club scene, compounding the lack of service availability or HIV prevention messaging. This lack of access is particularly problematic for people who inject stimulant drugs, who would benefit from access to an NSP and other services. Creative strategies can be used to make sterile needles and syringes available to people who inject stimulant drugs, particularly outside operating hours, and in the places where stimulant drugs are purchased or used. These may include satellite NSPs in projects or clinics for key populations, needle and syringe dispensing machines, secondary NSP, outreach programmes, safer clubbing initiatives, outreach at sex-on-premises venues (bars, saunas, clubs, etc.), outreach programmes at festivals, and community mobilization initiatives. NSPs designed to address the needs of people who use stimulant drugs, including all key populations, are well positioned to provide an entry point to a coordinated cascade of services, starting with voluntary HTS. They can also offer information on how to reduce risks related to the use of drugs, distribute female and male condoms and lubricant, and provide route transition interventions (see below). Efforts to understand the context of an individual’s drug use, their injecting equipment needs, and their concurrent sexual behaviours will help ensure that appropriate messaging is used. NSPs should also provide education, advice and equipment to support safer injecting practices, including on the importance of hand hygiene, avoiding sharing any paraphernalia (filters, water) associated with injecting, and keeping even the smallest amounts of blood out of the space where drugs are prepared for injection. It is also important to provide syringe disposal bins or plastic bins or containers for the safe disposal of used injecting equipment, which is key to preventing needle-stick injuries and reducing risk or inconvenience to the wider community associated with illicit drug injection. Syringes with colour-coded barrels provide an example of a promising practice that supports people who inject stimulant drugs in group settings. Each participant is assigned a different colour and provided with syringes of that colour which he or she alone is to use. This can help reduce the accidental sharing of injecting equipment, particularly if it is reused. Route transition interventions Route transition interventions support people who use drugs to avoid initiation into injecting, or to encourage people who are injecting to transition to non-injecting routes of administration. Behavioural interventions, peer education interventions and the provision of commodities that support alternatives to injecting, such as pipes, mouthguards and aluminium foil, can be used to engage with people who inject heroin and/or stimulant drugs. Box 3. A harm reduction programme for people who smoke cocaine or methamphetamines in the Pacific North-West United States The People’s Harm Reduction Alliance (PHRA) is a peer-based harm reduction programme for people who use drugs in the Pacific North-West of the United States, established in 2007. In its first year, PHRA provided syringes and sterile injection equipment; however, the need to expand services to include people who smoke drugs became quickly apparent via the peer-based framework and feedback from clients. In 2008, PHRA launched a crack pipe programme to reach a different group of people who use drugs. The programme has become a point of contact for them to access additional services. In 2015, the programme was expanded to include methamphetamine pipes because participants informed PHRA that lack of access to pipes led them to inject more frequently than they would otherwise do. Both pipe programmes have increased the inclusion of people who smoke crack and methamphetamine at PHRA and linked them to other essential health services. In 2016, PHRA expanded services for non-injectors further with a snorting programme. HIV and HCV prevention opportunities for people who smoke stimulant drugs Crack cocaine, cocaine base and methamphetamine can be smoked in a pipe, offering access to the high-dose surging effect. The repeated use of heated crack pipes can cause blisters, cracking and sores on the tongue, lips, face, nostrils and fingers. It has been suggested that this may facilitate HCV transmission via unsterile paraphernalia (although this has not been clearly established). People smoking stimulant drugs in pipes do not require single-use equipment but will benefit from having personal (individual) smoking equipment, and messaging that pipes should not be shared. The same principle applies for straws used to inhale cocaine. The distribution of pipes, mouthguards and other piping paraphernalia provides practical strategies for engaging stimulant drug smokers and reinforces the “Don’t share pipes” message. The principles of distributing paraphernalia and engaging people who smoke stimulant drugs with messages about HIV and hepatitis prevention remain the same. 25 Chapter 2 Core interventions Box 4. Example of content of kits for safer smoking • Pipes • Mouth- or lip guards – a rubber band, rubber tubing, or sometimes specially produced • Stainless steel wool, used as gauze to suspend the crack cocaine inside the pipe • Alcohol wipes to clean the pipe and reduce risks associated with sharing • Lip balm containing vitamin E, to help protect and heal chapped or injured lips • Sterile dressing to cover wounds or burns arising from smoking crack • Sugar-free chewing gum which can help stimulate saliva production to protect teeth and reduce dental damage • Condoms and lubricants to support safer sex practices • Health promotion leaflets Safe tattooing In some population groups who use stimulant drugs, unsafe tattooing is frequent and constitutes a risk for transmission of HCV. This is a particular issue in prisons where tattooing is prohibited and hidden and unhygienic tattooing is common. NSPs and other low-threshold services can offer safe tattooing information, training and safe equipment. 2.3 HIV testing services HIV testing provides an opportunity to deliver HIV prevention messages and to link people to HIVprevention and other relevant health and support services. HIV testing services (HTS) are also the critical entry point to ART (see section 2.4). Given the evidence that individuals who are ARTadherent and have achieved viral suppression do not transmit HIV, HTS is a crucial component of HIV prevention programmes. It is important to increase the opportunities for people who use stimulant drugs to access and use confidential, easy and convenient HIV testing that is linked to the provision of ART for those who test positive. Community-based rapid HIV testing provides an opportunity to deliver results immediately. This can be of particular importance with street- or venue-based people who use stimulant drugs, where the primary source of engagement may be outreach programmes brought to where they are, rather than waiting for them to present at a specific testing location. Other outreach opportunities may also be used to distribute HIV self-test kits. Regardless of the testing modality, it is important to have a protocol to assist people to get a confirmatory test if they test positive, and to access and successfully use HIV care and treatment services if needed, including immediate access to ART, post-exposure prophylaxis (PEP) or PrEP, as appropriate. On-site HIV testing can pose challenges, including the possible lack of confidentiality that comes especially with small, closed communities. Outreach workers and service providers need to ensure that HIV testing is always voluntary and that coercive use of self-test kits by third parties such as law enforcement or employers to test any individual (e.g., sex workers) is unacceptable. 2.4 Antiretroviral therapy Antiretroviral therapy (ART) is the treatment of people living with HIV with medications that suppress the replication of the virus. Currently the standard treatment consists of a combination of antiretroviral drugs (ARVs), and it is indicated for all people living with HIV, irrespective of their CD4 count. ART reduces morbidity and mortality rates among people living with HIV, improves their quality of life and reduces risks of transmission of HIV. ARVs are also administered to some groups of people at risk for HIV acquisition either before exposure (PrEP) or after (PEP). ART is also needed for prevention of mother-to-child transmission of HIV. Cocaine and ATS have been associated with faster disease progression in people living with HIV, due to weakening of the immune system by the drugs. However, if adherence is maintained, the effectiveness of ART is not reduced in people who use stimulant drugs: ART reduces viral load and improves immune function, just as it does for other people living with HIV [77]. Strategies to support adherence to ART, including peer and outreach support, are described in section 3.1. Side-effects of antiretroviral drugs and interactions with stimulant drugs As with many medications, ARVs have been associated with various side-effects, including acute or chronic alterations of the renal function, or hepatic dysfunction. Some medications can cause sideeffects in the central nervous system, such as depression. Liver toxicity is one of the most commonly reported adverse consequences associated with ARVs. This can range from asymptomatic elevation of the liver enzymes to a hepatic failure. Risks for ARVrelated adverse consequences for the liver are higher in cases of cocaine use, excessive alcohol use, coinfection with HBV or HCV, fibrosis of the liver, concomitant treatment for TB and advanced age. Impact of stimulant drugs on antiretroviral drug serum level Cocaine, mephedrone and methamphetamines interact with several ARVs, influencing the serum level of the medications and the risk of side-effects. As scientific knowledge progresses, new ARV regimens may be proposed, with the potential for interactions with the NPS that are frequently appearing on the market. The University of Liverpool provides a regularly updated website on HIV medication interactions, including the interaction of ARVs with stimulant drugs: https://www.hiv-druginteractions.org/treatment_selectors. Impact of antiretroviral drugs on serum level of stimulant drugs Serum levels of methamphetamines may increase up to three times when used by someone who is also taking protease inhibitors, especially ritonavir. Fatal cases attributed to inhibition of the metabolism of MDMA and amphetamines by ritonavir have been reported. Oral pre-exposure prophylaxis Oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral medications to prevent the acquisition of HIV infection by uninfected persons. WHO recommends daily oral PrEP as a prevention choice for people at substantial risk of HIV [91]; it can be stopped during periods of low or no risk. Taken as prescribed, PrEP can reduce the risk of getting HIV from sex with an HIV-positive person by more than 90 per cent [92]. PrEP has been effective in communities where the primary vector for transmission is sexual, such as men who have sex with men, and is therefore appropriate for people who use stimulant drugs. PrEP does not replace HIV prevention interventions, such as comprehensive condom programming for sex workers and men who have sex with men. It does not prevent transmission of hepatitis and other STIs. Services for people who inject stimulant drugs should prioritize evidence-based comprehensive HIV prevention interventions, including NSP, condoms and lubricants. For men who have sex with men who use stimulant drugs and engage in high-risk sex, PrEP should always be proposed, whether or not the individual injects drugs. Adherence to PrEP is essential, and it may be challenging for people using stimulant drugs for several days in a row. People who use stimulant drugs and engage in concurrent sex should be encouraged and supported to plan ahead to use condoms, lubricants and PrEP in combination, to ensure better protection against HIV and to prevent other STIs, including hepatitis C and B. As with other prevention tools, the effectiveness of PrEP is optimized when interventions are implemented by, and in close consultation with, prospective beneficiary communities. Further resources Implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection (WHO, 2017) [93] Post-exposure prophylaxis Post-exposure prophylaxis (PEP) is the administration of ARVs for a short term (one month) to prevent HIV infection after exposure to HIV through unprotected sex or contact with blood. PEP should be offered to all individuals who have potentially been exposed to HIV, whether through unprotected sex (including sexual assault), needle-stick injury or sharing drug injection equipment. It should be initiated as early as possible, ideally within 72 hours. People who use stimulant drugs and engage in sex concurrently are known to often have multiple sexual partners. The chances of unprotected sex or condom failure are increased with stimulant drug use or with the increase in the number of partners. A participative stakeholder process should lead to the development of protocols for community access to PEP, from local to national levels, to ensure that the required medications are promptly accessible and are used by those who need them. People who use stimulant drugs and who access PEP regularly should be assessed as likely candidates for PrEP. Further resources Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] 2.5 Evidence-based psychosocial interventions and drug dependence treatments The impact of a drug is determined by the complex interactions between the substance, set (the mindset of the individual) and setting (the context), which mediate the drug’s effect and its associated impact on the individual, including the move towards dependent or high-risk drug use [94]. The great majority of people who use stimulant drugs do so on an occasional basis that may be characterized as “recreational”, and they will not develop dependence. This group has little need for high-intensity interventions. This section provides an overview of possible interventions, mainly psychosocial ones, that show effectiveness specifically for reducing risk behaviours and provide support for people who regularly use stimulant drugs, including people living with HIV. 29 Chapter 2 Core interventions The treatment of cocaine or ATS drug dependence requires time-intensive approaches that are not addressed here. Unlike the treatment of opioid dependence, there are currently no substitution medications available to treat dependence on cocaine or ATS [95][96]. Some emerging practices around dispensing dexamphetamine as a substitute for cocaine or methamphetamine dependence have shown early promise, but further research is needed. Behavioural interventions, self-regulation coaching and psychosocial counselling can support HIV/HCV prevention and treatment objectives for people who use stimulant drugs, while also contributing to longer-term and broader health and wellness goals. There is evidence that brief interventions that concentrate on providing information about safe behaviours and harm mitigation are effective in moderating drug-related harms [97] and maintaining ART adherence for those who are living with HIV [98]. Addressing the potential risks associated with the nexus of drug use and HIV requires individual, structural and combination approaches [99]. Psychosocial services such as motivational interviewing, brief interventions, contingency management and cognitive behavioural therapy are critical to effectively support HIV prevention and treatment among people who use stimulant drugs. Some of these approaches are described below. A 2016 review of psychosocial interventions for stimulant drug-use disorders found that all showed improved retention in ART compared with no intervention, although no single intervention showed a sustained benefit over the others [100]. Psychosocial services should be based on principles of community inclusion and participation, peer support and the needs of the individual. When developing HIV prevention interventions, it is important that sexual partners of people who use stimulant drugs be included in the process, focusing on the HIV risks that are associated with drug use and concurrent sexual behaviours. Motivational interviewing Motivational interviewing is a person-centred, semi-directive approach for exploring motivation and ambivalence in order to facilitate self-motivational statements and behavioural changes. It consists in establishing a partnership between the provider and the individual and enabling the individual to become aware of the discrepancy between their present situation and their own values. The technique relies on four principles: express empathy, develop discrepancy, roll with resistance and support selfefficacy. These can easily be used by trained non-specialist staff, including outreach workers, in formal or informal counselling, IEC and other conversations. Motivational interviewing generally requires just one or two sessions. The success of motivational interviewing has led to its implementation as a “catch-all” approach to eliciting change in areas such as medication compliance, smoking cessation and diet and exercise [101]. A 2012 Cochrane review suggested that motivational interviewing could reduce risky sexual behaviour, and in the short term lead to a reduction of viral load in young people living with HIV [102]. Research has shown that motivational interviewing can reduce the incidence of unprotected anal intercourse among men who have sex with men [103], as well as levels of drug use [104]. Brief interventions Brief interventions are short, often opportunistic interactions in which a health worker provides targeted information and advice to individuals during other activities such as distributing sterile injecting equipment or conducting an HIV test. Brief interventions have been shown to reduce drug use as well as associated risks and sexual risk behaviours. Meta-analyses suggest that there is little difference in the outcomes between longer, more intensive interventions and brief interventions, and the latter are likely to be more practical and cost-effective options, with few barriers to implementation [105]. Motivational interviewing, contingency management and brief interventions for dependence to stimulant drugs can reduce drug-related high-risk sexual behaviours and increase adherence to ART and PrEP. 30 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Contingency management Contingency management is an approach that incentivizes people with rewards such as cash that are contingent on achieving a set of pre-defined outcomes. Contingency management has been shown to have a moderate yet consistent effect on drug use across different classes of drugs [106]. The effectiveness of contingency management supports the idea that small, regular rewards motivate people to modify behaviours that could be considered harmful. Positive regard, and the client’s own expressed belief in their ability to achieve goals, are a critical factor in improving agreed-upon outcomes. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) is a structured approach to counselling that assumes that behaviours are learned and reinforced as a result of cognitive constructs and deficits in coping. The aim of CBT is to “unlearn” behaviours considered unhelpful, such as HIV risk behaviour or certain patterns of drug-taking. While results appear to be sustained over a period, CBT is intensive and time-consuming, and demands specialist practitioners and individual treatment [107]. Mindfulness Mindfulness can be defined as the ability to focus open, non-judgemental attention on the full experience of internal and external phenomena, moment by moment. Positive outcomes – including reducing drug use and risk behaviours, and in relapse prevention – have been documented from mindfulness training as part of approaches to reduce harm, including for people who use stimulant drugs [108][109][110]. Opioid substitution therapy and stimulant drug use People receiving opioid substitution therapy (OST) for heroin or other opioid dependence may use stimulant drugs because of OST-triggered fatigue, inability to experience pleasure, or the desire to remain connected to the community of people who use drugs. OST is not designed to counter stimulant drug use, and the concurrent use of stimulant drugs while on OST should not be viewed as a breach, nor should it lead to the reduction or discontinuation of OST. The benefits of OST are independent of stimulant drug use [111]. Existing OST providers should be sensitized to this and trained to use the opportunities afforded by regular OST and client engagement to support the delivery of interventions included in this guidance. Further resources mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings (WHO, 2010) [112] Therapeutic interventions for users of amphetamine-type stimulants (WHO, 2011) [113] Harm reduction and brief interventions for ATS users (WHO, 2011) [114] Guidelines for the management of methamphetamine use disorders in Myanmar (Ministry of Health and Sports, Myanmar, 2017) [115] Guidance for working with cocaine and crack users in primary care (Royal College of General Practitioners, 2004) [116] Principles of drug dependence treatment (UNODC, WHO, 2008) [117] Drug abuse treatment and rehabilitation: a practical planning and implementation guide (UNODC, 2003) [118] TREATNET quality standards for drug dependence treatment and care services (UNODC, 2012) [111] Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (WHO, 2009)[163] Treatment of stimulant use disorders: current practices and promising perspectives. Discussion paper (UNODC, 2019)[164] 31 Chapter 2 Core interventions 2.6 Prevention, diagnosis and treatment of sexually transmitted infections, hepatitis and tuberculosis Screening people who use stimulant drugs for infectious diseases, such as sexually transmitted infections (STIs), HBV, HCV and TB, is a crucial part of a comprehensive approach. Along with HIV, these infections are often associated with the use of illicit substances, and they may co-occur with stimulant drug use. Prevention, diagnosis and treatment of sexually transmitted infections Unsafe sex can lead to acute STIs, which can cause infertility and severe illness. Several STIs, particularly those involving genital or perianal ulcers, may facilitate the sexual transmission of HIV infection. Sex workers, transgender people and men who have sex with men are often at increased risk of STIs such as syphilis, gonorrhoea, chlamydia and herpes. It is therefore important to offer information, male and female condoms and lubricant, and screening, diagnosis and treatment of STIs and possibly HPV vaccine to people using stimulant drugs who are vulnerable to STIs and HIV. Further resources Resources on sexually transmitted and reproductive tract infections (WHO webpage providing clinical, policy and programmatic, monitoring and evaluation and advocacy guides) [119] Prevention, vaccination, diagnosis and treatment of hepatitis B and C People who inject stimulant drugs are at heightened risk of acquiring HBV and HCV because of frequent injecting and sharing of injection equipment. The risk of sharing equipment is higher when injecting happens in communal settings. HCV is much more virulent than HIV and can survive outside the body at room temperature, on environmental surfaces, for up to three weeks [120], making it more easily transmitted through the sharing of syringes and other injecting paraphernalia. Key populations who use stimulant drugs should be offered hepatitis B or hepatitis A-B vaccination, access to prevention commodities, and voluntary screening and treatment of HBV and HCV. Prevention NSPs and community mobilization initiatives should distribute relevant equipment, including low dead-space syringes, for injecting, smoking and snorting (see section 2.2). Male and female condom programming is also part of hepatitis B and C prevention interventions as well as sexual and reproductive health services. Education should include messages on the risks of serosorting, and of intense sexual practices involving potential trauma of the mucosa for HCV acquisition and transmission among people living with HIV [50]. Hepatitis A and B vaccination Key populations should be offered the series of HBV immunizations. WHO recommends: • Offering people the rapid hepatitis B vaccination regimen (days 0, 7 and 21-30). • Providing people who inject drugs with incentives in order to increase hepatitis B vaccination adherence, at least for the second dose. Even partial immunization confers some immunoprotection. [87] Hepatitis A (HAV) immunization or combined HAV-HBV immunization should be offered to men who have sex with men and people using stimulant drugs [121]. 32 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Immunization should be easily accessible and offered at locations and venues frequented by people who use stimulant drugs, such as drop-in centres, NSPs and other community service outlets. Screening for HBV and HCV Voluntary screening for HBV and/or HCV should be offered to people who use stimulant drugs at risk of these infections. Testing and diagnosis of HBV and HCV infection is an entry point for accessing both prevention and treatment services. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay the progression of liver disease. Rapid tests for hepatitis C allow for better access to diagnosis, including communitybased testing. Treatment of chronic hepatitis C or B All people with chronic hepatitis C should receive treatment. With an 8- to 12-week course, directacting antivirals (DAAs) cure more than 95 per cent of persons with HCV infection, reducing the risk of death from liver cancer and cirrhosis. For chronic hepatitis B, antiviral treatment can slow down the progression of cirrhosis and reduces the risk of liver cancer [162]. People who are actively injecting drugs have been shown to adhere to HCV treatment regimens as well as any other population, particularly when social, emotional and practical support are provided [122]. All people who use stimulant drugs living with HCV should therefore be offered access to direct-acting antivirals without discrimination. Further resources Guidance on prevention of viral hepatitis B and C among people who inject drugs (WHO, 2012) [87] Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection (WHO, 2016) [123] Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] Prevention, diagnosis and treatment of tuberculosis In 2016, 10.4 million people fell ill with TB. It is a leading killer of people living with HIV: in 2016, 40 per cent of HIV deaths were due to TB [124]. Transmission of TB is easily facilitated through airborne particulates, such as by kissing, coughing, sneezing or shouting. TB is easily spread in prisons and other closed settings, and in crowded and poorly ventilated spaces, such as are often found in poor communities or among homeless people. People who inject drugs are at increased risk of TB, irrespective of their HIV status, and TB is a leading cause of mortality among people who inject drugs who also have HIV infection [125]. People who use drugs who do not inject have also been found to have increased rates of TB. Certain subgroups of stimulant drug users, such as those who use stimulant drugs regularly for days at a time, may be immuno-deficient from lack of sleep and food, facilitating TB transmission. It is therefore important to include TB prevention, screening and treatment in communities and services. Further resources Integrating collaborative TB and HIV services within a comprehensive package of care for people who inject drugs: consolidated guidelines (WHO, 2016) [125] 33 Chapter 2 Core interventions 2.7 Targeted information, education and communication To reduce the risk of acquiring STIs or HIV, people who use stimulant drugs need knowledge and support. Information, education and communication (IEC) provides information, motivation, education and skills-building to help individuals adopt behaviours that will protect their health. Effective communication for health targeting people who use stimulant drugs requires addressing two challenges: • Crafting messages that can overcome long-standing distrust and fear. • Finding effective means of reaching people who use stimulant drugs with life-saving messages and materials. Key to meeting these challenges is meaningful engagement with the target audience of people who use stimulant drugs. Communities should be represented at every stage of IEC development, including the overall strategy and concept, and the development, testing, dissemination and evaluation of messages. Working with the community will help ensure that tools and materials are accurate and will be trusted and used. Recipients of IEC who have invested their own ideas and time in it will be more likely to stand behind the results and be active participants, not only in their own health but in health promotion in their community. Materials must be easily understandable and to the point. Interactive materials on a digital platform can tailor messaging to the specific situation of the service user and are often helpful in maintaining attention. On the other hand, traditional printed materials have the advantage of not requiring computer, phone or Internet access. They also provide an opportunity for outreach workers or other programme staff distributing the materials to interact with the service users, and a means for service users to easily share information with others. Using information technology to support behavioural interventions Online and social media can be a cost-effective manner of reaching targeted audiences. A local assessment can show where using these technologies will be advantageous and appropriate. Free WiFi at drop-in centres and other community points of congregation provides opportunities for access and use. Where people who use stimulant drugs have smartphones, websites and apps can be deployed just as they have been to reach other key populations. The use of technology has shown promising results in promoting sexual health or adherence to ART in different settings, including resource-limited settings [126][127]. Web-based applications provide an opportunity to reach a large audience at any time and provide information on health and available services. They also allow for online outreach and interactions with people who wish to discuss problems or have questions. However, when the information relates to drug use, or other criminalized behaviours, the use of some digital media raises concerns about the anonymity of the contacts, and possible risks related to law enforcement must be addressed. Working with communities and low-threshold service providers will help inform the local potential for digital materials and campaigns and help ensure the security of people accessing information. Given the variety that exists among people who use stimulant drugs, messaging should take into account the sex, gender, sexual orientation, age and setting of recipients of IEC. Literacy levels, social and community inclusion or exclusion, and other cultural and societal variables must also be considered. 34 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Further resources The European Centre for Disease Prevention and Control (ECDC) has developed guidance documents for the effective use of social media. While the tools were developed for Europe, and specifically for reaching men who have sex with men, they provide guidance on the relative advantages of different media, such as Facebook, online outreach, Google Ads, SMS and YouTube, that may be useful in other contexts. Effective use of digital platforms for HIV prevention among men who have sex with men in the European Union/European Economic Area: an introduction to the ECDC guides (ECDC, 2017) [128] 2.8 Overdose and acute intoxication prevention and management Very high doses of stimulant drugs consumed in a short amount of time can trigger acute respiratory distress, chest pain, palpitations or myocardial infarctions [112]. In extreme cases this can result in cardiac arrest. The first signs of stimulant drugs intoxication are hyperactivity, rapid speech and dilated pupils. In the case of polydrug use, overdose can be the result of the combination of stimulants with other drugs including opioid or sedative drugs. The treatment of stimulant drugs intoxication is symptomatic and requires regular monitoring of blood pressure, pulse rate, respiratory rate and temperature (figure I.). Serotonergic syndrome is caused by an excess of serotonin in the central nervous system associated with the use of ATS. It can result in uncontrollable muscle spasms, tremor, seizures, psychosis, high blood pressure, high body temperature >400 C (hyperthermia) and release of myoglobin from muscles and blood clotting in vessels (disseminated intravascular coagulation), which may lead to severe diseases and potentially death. People who use stimulant drugs need to be informed on how to reduce the risks of acute intoxications (see the Information checklist for self-care and stimulant drugs in the annex). For people on PrEP, ART or hepatitis treatment, information should be provided on the interactions and possible risks of cocaine and ATS use to serum levels (see section 2.4). People who use stimulant drugs should be trained to recognize overdoses, provide first aid, including cardiopulmonary resuscitation (CPR) and call immediately for emergency professional assistance if they witness an overdose.
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Purpose of this guide The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses. It aims to: • Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations • Provide implementation guidance to help establish and expand access to core HIV and hepatitis prevention, treatment, care and support services It is a global document that should be adapted according to the specific context, including the type of stimulant drug used (cocaine, ATS or NPS) and the key populations involved, which vary considerably according to regions. The present guide proposes a package of core interventions adapted from existing international guidance: • WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users[7] • WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations – 2016 update [8] • Implementing comprehensive HIV and HCV programmes with people who inject drugs: practical guidance for collaborative interventions (the “IDUIT”) [9] It also incorporates guidance from the implementation tools for other key populations: • Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions (the “SWIT”) [10] • Implementing comprehensive HIV and STI programmes with men who have sex with men: practical guidance for collaborative interventions (the “MSMIT”) [11] • Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions (the “TRANSIT”) [12] However, none of these guidance documents and tools addresses the specific needs of people who use stimulant drugs and are at risk for HIV and hepatitis B and C – hence the need for this publication. Audience The guide is intended for use by policymakers, programme managers and service providers, including community-based organizations, at the national, regional or local levels, who undertake to address HIV prevention, treatment and care. It also provides useful information for development and funding agencies and for academia. Structure The guide is divided into five chapters. • Chapter 1 explains the nature and effects of stimulant drugs, the associated risks of HIV and hepatitis transmission, and the issues surrounding stimulant drug use and HIV and hepatitis risk in specific key populations and other vulnerable groups. 10 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Chapter 2 presents the package of core HIV interventions for key populations who use stimulant drugs. • Chapter 3 describes approaches to care and support for people who use stimulant drugs, particularly in the context of HIV and hepatitis. • Chapter 4 describes six critical enablers – activities and strategies that are needed to ensure access to the interventions in the core package. • Chapter 5 outlines further considerations for implementing programmes. Within each chapter, further resources are listed. Case studies are provided throughout the guide to illustrate specific aspects of programmes that have been implemented in different countries. There is also an annex presenting a series of checklists and other practical tools for policymakers and implementers. Principles Two important overarching principles are stressed throughout this publication. The first is better integration of HIV, hepatitis B and C and sexually transmitted infection (STI) services for people who use stimulant drugs within existing HIV harm reduction services2 and drug treatment services for people who inject drugs, and within sexual and reproductive health and other HIV services for key populations. The second is the meaningful involvement of people who use stimulant drugs, people living with HIV and other key populations in planning, implementing, monitoring and evaluating interventions. This is key to their success and sustainability. Finally, the implementation of HIV-related services for people who use stimulant drugs should adhere to human-rights principles as described in the implementation tools mentioned above – the SWIT, MSMIT, TRANSIT and IDUIT. Methodology In its June 2009 session, the UNAIDS Programme Coordinating Board (PCB) called upon “Member States, civil society organizations and UNAIDS to increase attention on certain groups of non-injecting drug users, especially those who use crack cocaine and ATS, who have been found to have increased risk of contracting HIV through high-risk sexual practices”. UNODC therefore commissioned a review and organized a Global Expert Group Technical Meeting on Stimulant Drugs and HIV, held in Brazil in 2010. A discussion paper on HIV prevention, treatment and care among people who use (noninjecting) crack and cocaine or other stimulant drugs, particularly ATS, was developed in 2012. In 2013 the UNODC HIV Civil Society Organization (CSO) group established a Stimulant Drugs and HIV working group, with representatives from civil society and experts on HIV and stimulant drugs. The group organized consultations with representatives of the community and CSOs, including on the margins of the International Harm Reduction Conference in Kuala Lumpur in 2015. 2 For the purposes of this guide, harm reduction is defined by the nine interventions of the “comprehensive package” of services detailed in the WHO, UNODC, UNAIDS Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (see citation 7). These are: 1. Needle and syringe programmes; 2. Opioid substitution therapy and other drug dependence treatment; 3. HIV testing and counselling; 4. Antiretroviral therapy; 5. Prevention and treatment of sexually transmitted infections; 6. Condom programmes for people who inject drugs and their sexual partners; 7. Targeted information, education and communication; 8. Prevention, vaccination, diagnosis and treatment for viral hepatitis; 9. Prevention, diagnosis and treatment of tuberculosis. 11 In December 2014, the Strategic Advisory Group to the United Nations on HIV and injecting drug use, consisting of representatives of networks and organizations of people who use drugs, academics, donors, implementers and United Nations organizations, recommended conducting a new literature review on stimulant drugs and HIV and hepatitis C. In 2015 UNODC, together with WHO and UNAIDS, defined the scope of this new literature review, and accordingly UNODC commissioned it to cover the extent, patterns and geographic distribution of injecting and non-injecting stimulant drug use (particularly crack, cocaine, ATS and stimulant NPS) in men who have sex with men, sex workers and other groups of stimulant drug users, and their possible link to HIV and hepatitis B and C vulnerability and transmission; and effective interventions for prevention, treatment and care of HIV and hepatitis B and C among people who use such stimulant drugs. The results of the literature review were published by UNODC in 2016 in five papers covering the following topics: • Methodology and summary [3] • ATS [13] • Cocaine and crack cocaine [14] • NPS [15] • Treatment and prevention of HIV, HCV & HBV among stimulant drug users[16]. Subsequently, in the framework of preparations for the United Nations General Assembly Special Session on the World Drug Problem (UNGASS 2016) and the HLM 2016, UNODC organized a scientific consultation on HIV and drug use, including stimulant drugs. The papers relating to stimulant drugs presented at the Commission on Narcotic Drugs in March 2016 covered: cocaine and crack cocaine use and HIV in the United States; ATS and men who have sex with men in Asia; and antiretroviral therapy (ART) and stimulant drug use. The recommendations of the contributing scientists were summarized as part of a scientific statement presented in New York on the margins of the UNGASS 2016 and the HLM 2016 [17]. The statement stressed the need to address HIV among people who use stimulant drugs, including the structural, social and personal mediating factors for HIV transmission, such as polydrug use, STIs, mental health, homophobia, discrimination and punitive laws. The scientists recommended the provision of ART to all people using stimulant drugs living with HIV, and the implementation of new prevention tools such as pre-exposure prophylaxis (PrEP) and the use of social media for communication. The statement also emphasizes that with proper support for adherence, ART is effective among people living with HIV who use stimulant drugs. In 2017, UNODC commissioned the development of the present publication, HIV prevention, treatment, care and support for people who use stimulant drugs: an implementation guide. Based on the results of the scientific reviews and of the expert group meetings, and on international guidance and country practices that have been identified as effective in meeting the needs of people who use stimulant drugs, a first draft of the document was developed under the guidance of the UNODC CSO Stimulant Drugs and HIV working group. The draft guide was reviewed by external peer reviewers, United Nations agency reviewers and community representatives through an electronic consultation and three face-to-face consultations held in Viet Nam (2017), Brazil (2017) and Ukraine (2018). Chapter 1 Stimulant drugs, HIV and hepatitis, and key populations The World Drug Report 2019 estimates that about 29 million people used ATS in 2017, and 18 million used cocaine [18]. There is no estimate of the total number of people using NPS. The great majority of people who use stimulant drugs do so on an occasional basis which may be characterized as “recreational”, and they will not develop dependence or any other health problem. There is evidence that the prevalence of ATS use, particularly methamphetamines, is increasing in some regions, including North America, Oceania and most parts of Asia. In addition, between 2009 and 2016, there were reports of 739 NPS, of which 36 per cent were classified as stimulant drugs [19]. Only a small proportion of people who use stimulant drugs inject them; most smoke, snort or use them orally or anally. However, the World Drug Report 2017 states that 30 per cent of people who inject drugs inject stimulant drugs, either as their drug of first choice or in addition to opiates. Despite evidence showing that certain subgroups of people who use stimulant drugs are at greater risk of HIV, prevention, testing and treatment programmes for these population groups remain very limited in scope and scale across the globe, and their specific needs are often overlooked. 1.1 Stimulant drugs Stimulant drugs are chemically diverse substances that are similar in their capacity to activate, increase or enhance the neural activity of the central nervous system, resulting in a common set of effects in most people who use them, including increased alertness, energy and/or euphoria.3 This publication considers three types of stimulant drugs for which data have shown a link with increased HIV risk among some key populations: • Cocaine: Found in various forms, e.g. smokable cocaine, crack cocaine, freebase, paste or pasta base, paco, basuco. Depending on the form, it may be sniffed or snorted, injected, ingested or inserted anally. 3 For more detailed information on different stimulant drugs and their effects, see: Terminology and information on drugs. Third edition. New York (NY), United Nations, 2016 (https://www.unodc.org/documents/scientific/Terminology_and_ Information_on_Drugs-3rd_edition.pdf, accessed 15 January 2019). 14 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Amphetamine-type stimulants: Amphetamines and methamphetamines (excluding MDMA) are found in different forms, e.g. crystals (methamphetamines), powder or formulated tablets [20]. They are taken orally, smoked from a pipe, sniffed or snorted, inserted anally or injected in a solution. • Stimulant new psychoactive substances: Found in various forms, e.g.synthetic cathinone, phenethylamines, aminoindanes and piperazines. They are sometimes referred to as “bath salts” [21][22]. Depending on the form, NPS are taken orally, smoked, inserted anally or injected. All types of stimulant drugs have common effects: • Mental: Euphoria, raised libido, reduced appetite and sleep drives, enhanced perception, increased alertness, cognitive improvements and deficits (attention, working memory, long-term memory), emotional intensity and excitability, and increased confidence. • Behavioural: Talkativeness, hypervigilance, hyperactivity, increased sociability, disinhibition, changes in sexual behaviour (including sexual sessions of longer than usual duration), faster reaction, and repetitive activity (“tweaking”); hyper-excitability, insomnia, restlessness, panic, erratic behaviour, and sometimes aggressive or violent behaviour[23]. • Physical: Increased heart rate (including palpitations), raised temperature (hyperthermia), circulatory changes (higher blood pressure, vasoconstriction), increased breathing rate, dry mouth, teeth-grinding, jaw-clenching/gurning, faster eye-movements, and dilated pupils. The onset and duration of these effects vary according to the drug, its form, dosage, route of administration, the characteristics of the individual using it, and the context of use. Chronic use of stimulant drugs can lead to psychological dependence; development of tolerance; destruction of tissues in the nose if snorted or sniffed; chronic bronchitis, which can lead to chronic obstructive pulmonary disease; malnutrition and weight loss; disorientation, apathy, confusion, exhaustion due to lack of sleep, and paranoid psychosis. During withdrawal there may be a long period of sleep and depression. Cocaine Cocaine is generally encountered in two forms which differ in their route of administration: cocaine hydrochloride (HCL), a powder, which is snorted, injected or taken anally, and cocaine base (crack, freebase, or crystal) which is smokable and usually taken in a pipe. A third form, coca paste (pasta base, paco, coca pasta, etc.), is an intermediate product of the process of extraction of HCL from the coca leaves. Available mainly in Latin America, it is usually smoked in a cigarette. Cocaine is a powerful stimulant whose effects diminish quickly, prompting the user to repeatedly administer additional doses. When snorted, cocaine produces a slow wave of euphoria, followed by a plateau and then a “come down” period. In its smokable form, cocaine has a more intense and immediate effect. Severe anticipatory anxiety about the impending low may result in repeat dosing. This cycle may take around 5 to 10 minutes. The use of cocaine is more prevalent in North and South America than in the rest of the world. Amphetamine-type stimulants (ATS) Amphetamine and methamphetamine are synthetic drugs whose effects include euphoria, arousal and psychomotor activation. ATS can be taken orally, intranasally, smoked as a vapour (pipe), inserted anally or injected. Immediately after smoking or injecting, people experience a pleasurable “rush”. Intranasal and oral ingestion produce a gradual euphoria or “come up”. Depending on the level of tolerance, the effects of methamphetamine may last four hours, or as long as 24 hours for someone new to the drug [24]. Some people who use methamphetamine may experience a feeling of invincibility, with an accompanying propensity to engage in high-risk behaviours, creating vulnerabilities to acquiring HIV [25]. The direct health impacts of ATS include insomnia and cardiovascular stress. Long-term negative effects may include dopamine physical dependence, psychological dependence, psychosis and paranoia, and depression. Amphetamine and methamphetamine use is reported in all parts of the world. Stimulant new psychoactive substances There are a various types of new psychoactive substances (NPS), with different molecular structures, but the majority of stimulant NPS are synthetic cathinones, which have a similar molecular structure to cathinone found in the khat plant. Common synthetic cathinones include mephedrone, pentedrone, methylone or methcathinone. They fall into two main families: euphoriants and entactogens.NPS are taken orally, can also be snorted or inserted anally, and less frequently are injected. Stimulant NPS produce similar mental, physical and behavioural effects to traditional stimulant drugs such as cocaine, amphetamines and methamphetamines. Synthetic cathinones and other stimulant NPS are also used to improve sexual experience [26]. The use of synthetic cathinone such as mephedrone (sometimes called “bath salts”) has recently emerged [18]. Studies from Hungary [27][28][29], Ireland [30][31], Israel [32], Romania [33] and the United Kingdom [34] suggest that due to a shortage in heroin supply and easy access to synthetic cathinone, a significant proportion of people who inject drugs have switched to injecting synthetic cathinone in recent years. 1.2 Stimulant drug use and risks of HIV/HBV/HCV transmission The HIV/HBV/HCV risk associated with stimulant drug use is linked to a higher prevalence of unprotected anal and vaginal sex, and of sharing pipes, straws and injection equipment, in some groups of men who have sex with men, sex workers, people who inject drugs and people in prisons. Transmission risks through concurrent stimulant drug use and unprotected sex Inconsistent condom use by people who use stimulant drugs has been identified as a prime means of contracting STIs, including HIV, particularly as a result of the concurrent use of stimulant drugs with frequent sexual activity of long duration with multiple partners or in groups. Stimulant drug use may also facilitate longer penetration (which can lead to condom breakages), and more intense acts such as fisting that increase the opportunity of anal and vaginal tears or bleeding. Transmission risks through sharing injection equipment Injecting methamphetamine, cocaine or NPS entails a similar risk to injecting other drugs when needles and injecting equipment are shared. Given that many stimulant drugs have a shorter duration of action compared with opioids, people who inject stimulant drugs report a higher frequency of injecting, with compulsive re-injecting and a greater likelihood of sharing and reusing needles and syringes that may be contaminated [22][34]. HIV and HCV risk is also increased when cocaine or crack is coadministered with heroin, including injection of heroin and cocaine (“speedballing”) [35]. Coexisting injecting drug use and unprotected sex further increases the likelihood of HIV and hepatitis transmission, especially in high-incidence communities. This pattern has been seen, for example, with the use of home-made ATS, such as boltushka in Ukraine. People who inject boltushka engage in high levels of injecting risk behaviours and in sexual risk behaviour post use. They are young and poor, and the great majority are already living with HIV [36]. Hepatitis C transmission through straws or pipes HCV is transmitted through blood or, less commonly, through sexual contact. HCV can be transmitted from a person living with hepatitis who has oral or nasal sores or lacerations through sharing of straws or pipes [37][38][39][40]. Compared with the general population, higher HCV prevalence rates, ranging from 2.3 to 17 per cent, have been observed among people who smoke or sniff stimulant drugs [41]. However, it is difficult to determine whether HCV transmission in these cases occurred through blood exposure, sexual activity, or both. 1.3 Stimulant drug use and HIV/HBV/HCV transmission risks among key populations Men who have sex with men There seems to be a clear association between ATS use among men who have sex with men and risk of HIV infection. Methamphetamine use has been associated with increased frequency of unprotected sex among some men who have sex with men, thereby increasing vulnerability to STIs, HBV and HIV [42][43][44][45]. Studies have indicated HIV prevalence rates among men who have sex with men who use methamphetamine ranging between 17 and 61 per cent, and HIV incidence ranging from 2.71 per 100 person-years [46] to 5 per 100 person-years [47]. The use of stimulant drugs by some men who have sex with men to facilitate sex (referred to as ChemSex)4 has been linked to decreased condom use, sex with multiple partners and other high-risk sexual behaviours that increase likelihood of HIV and HCV transmission [48][49]. Increased sexual risk behaviours, including unprotected sex, coupled with potential anal or rectal trauma resulting from longer, more frequent and intense sexual encounters under the influence of drugs, could facilitate STI transmission among men who have sex with men, including HCV among men who have sex with men living with HIV. Risk-reduction strategies for HIV prevention such as serosorting5 and strategic positioning6 are inefficient for the prevention of other STIs, HBV or HCV. The association between ChemSex, drug use and sexually transmitted acute HCV infection among men living with HIV who have sex with men has been documented in several countries and regions [50]. ChemSex is mostly associated with non-injecting drug use, although some may also inject synthetic cathinones, amphetamines and methamphetamines (referred to as “slamming” or “blasting” within the context of ChemSex) [51], with a high level of sharing of injection equipment and consequently higher risks of HIV and HCV transmission [52][53][54]. Mephedrone use seems to have risen among men who have sex with men in the context of ChemSex [52]. The use of erectile dysfunction medications such as sildenafil is often reported among men who have sex with men who also consume methamphetamines and has been identified as increasing rates of unprotected sex and HBV, syphilis and HIV risks [46][48][55]. People who inject drugs Injecting stimulant drugs carries the greatest risk of acquiring HCV or HIV, due primarily to the sharing of contaminated needles and syringes. People who inject cocaine, ATS or heroin have a risk of acquiring HIV that is respectively 3.6, 3.0, and 2.8 times greater than people using stimulant drugs without injecting [56]. Outbreaks of HIV or hepatitis C among people who inject drugs, partly due to the increased use of synthetic cathinone as a replacement for heroin, have been reported in Greece [57], Hungary [29] and Romania [33][58]. People who inject stimulant drugs such as ATS show higher prevalence of sexual risk behaviours compared with people who inject opiates, and similar to non-injecting ATS users [59][60][61][62]. Sex workers Exchanging sex for crack cocaine or money has been associated with several HIV risk behaviours, such as having a greater number of clients per week [63], high levels of unprotected sex [64], sharing crack cocaine with clients [65] and heavier crack use, as well as structural vulnerabilities like homelessness and unemployment [66]. One study reported a higher HIV prevalence among those who exchange sex for drugs or money than among those who did not [67]. Individuals with drug dependencies who exchange sex for drugs may have reduced power and control over sexual interactions [68]. The use of methamphetamines by female sex workers has been associated with engaging in unsafe sex [69]. Female sex workers who use smokable cocaine are often homeless or poorly housed in economically depressed neighbourhoods, and have poor access to health services, including HIV services, as well as to prenatal and reproductive care and to social support. Sex workers, whether male, female or transgender, may be coerced into consuming drugs with their clients, increasing the risk of unprotected sex and violence. Male, female and transgender sex workers face barriers to accessing and using services due to the multiple stigma surrounding drug use, sex work and sexual orientation, which are criminalized to varying degrees in many jurisdictions around the world. Transgender people The use of methamphetamines, smokable cocaine or cocaine among transgender women has been associated with higher risks of HIV transmission, mainly through sex [70][71]. For example, a survey conducted among transgender women in high-risk venues and on the streets of Los Angeles, United States, indicated that recent methamphetamine and/or smokable cocaine use was associated with a more than twofold higher risk of reported HIV-positive status [72]. People living in prisons and other closed settings People who use stimulant drugs, such as methamphetamine, in prisons are more likely to engage in a number of sexual risk behaviours, including use of methamphetamines in the context of sex and inconsistent use of condoms [73][74]. 18 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Women who use drugs Women who use drugs face stigma and other barriers to accessing essential health and HIV services, including gender-based violence, fear of forced or coerced sterilization or abortion, or loss of child custody. Cross-cultural stigma associated with women vacating gender roles, such as caring for their family, being pregnant and being mothers of infants and children, is a major challenge [75]. Many women who use drugs face unequal power dynamics in relationships, and higher rates of poverty; these factors interfere with their ability to access reproductive health supplies, including condoms and other contraceptives [76]. People living with HIV Although cocaine or methamphetamine use has a negative impact on the immune system, particularly among people living with HIV, the immunodepressive effect disappears when people living with HIV who use stimulant drugs adhere to antiretroviral therapy [77]. People living with HIV using stimulant drugs experience the worst HIV outcomes when they do not know they are living with HIV, or cannot access ART. A review of the literature reports findings that psychological, behavioural and social factors all play a role, separately and in combination, in determining HIV outcomes in patients, their access to health services, and adherence to ART: • In people living with HIV, regular methamphetamine use has measurable negative effects upon neuropsychological functioning (e.g. deficits in episodic memory, executive functions and information-processing speed) [78] over and above the negative neurocognitive effects caused by HIV and HCV [79]. This may impact their health-protective behaviour, health-services-seeking, access to HIV clinics and adherence to ART. In addition, HIV-specific traumatic stress and related negative affect are independently associated with greater stimulant-drug risk behaviours and reduced ART adherence [80]. • Cocaine and ATS have a negative impact on the immune system, increasing vulnerability to opportunistic diseases and accelerating the evolution of HIV among people who do not adhere to ART [77][81]. (See section 2.4 for more information on the interactions between ART and stimulant drugs). • Some communities of people who use stimulant drugs are very marginalized, extremely poor and have few resources, including access to adequate nutrition, and this also impacts their access to services and consequently the evolution of HIV infection. To reach people who frequently use stimulant drugs and retain them in effective HIV treatment regimes, access and adherence barriers related to HIV treatment must be accurately identified and addressed. When assessing why a patient who uses stimulant drugs is lost to follow-up, important factors that should be considered include stigma, discrimination, mental health, employment status, poverty, homelessness, migration, exposure to violence, incarceration, fear of criminalization, and family responsibilities. See chapter 4 for more information. 1.4 The impact of criminal sanctions on HIV transmission among key populations Stigma, discrimination and criminal sanctions against people who use drugs, men who have sex with men, transgender people, sex workers and people living with HIV have a direct impact on their ability and willingness to access and use HIV and other health services. These also impede the ability of people from key populations to access the commodities or services needed to practise protective behaviours, including condom use, and to access sterile injecting equipment, HIV testing and HIV treatment. A systematic review of 106 peer-reviewed studies published between 2006 and 2014 examined the association between criminal sanctions for drug use and HIV prevention and treatment-related outcomes among people who inject drugs [82]. While the studies were mainly conducted in North America and Asia, the findings highlighted that criminal sanctions were responsible for substantial barriers to HIV treatment and prevention interventions for people who inject drugs. 21 Chapter 2 Core interventions Following an extensive literature review and technical consultations at country and global levels, expert participants in a number of consultations agreed on a package of eight core interventions for HIV prevention, treatment, care and support among people who use stimulant drugs and are at risk of HIV. These interventions have been adapted from the WHO/UNODC/UNAIDS Comprehensive Package for HIV and people who inject drugs, and from the WHO Consolidated Package for HIV and key populations [7][8]. 1 Condoms, lubricants and safer sex programmes 2 Needle and syringe programmes (NSP) and other commodities 3 HIV testing services (HTS) 4 Antiretroviral therapy (ART) 5 Evidence-based psychosocial interventions and drug dependence treatments 6 Prevention, diagnosis and treatment of STIs, hepatitis and tuberculosis (TB) 7 Targeted information, education and communication (IEC) for people who use stimulant drugs and their sexual partners 8 Prevention and management of overdose and acute intoxication The core interventions should be adapted to the specific needs of different key populations. An assessment of the population to be served will assist in providing the evidence needed to design a clientcentred package of services that responds to specific needs. 2.1 Condoms, lubricants and safer sex programmes People who have sex while under the influence of stimulant drugs are more likely to engage in sexual risk behaviours, especially unprotected sex [83]. They may have reduced sexual inhibitions and a feeling of invincibility, which makes choosing or remembering to use a condom more challenging. Other factors that can contribute to inconsistent condom use include lack of access to condoms and lubricants when needed, poor safe-sex negotiations skills, being on PrEP [84] and engaging in risk-reduction strategies such as serosorting or strategic positioning. These strategies have their limits in terms of risk for HIV transmission, particularly if people are under the influence of stimulant drugs, and they do not prevent transmission of other STIs including HBV and HCV. Promoting the use of male and female condoms and appropriate lubricants remains a core HIV prevention strategy for people who use stimulant drugs and their sexual partners. Condoms offer protection against HIV, other STIs such as syphilis and gonorrhoea, and possible sexual transmission of HBV or HCV. Condoms can also prevent unintended pregnancy. Condoms and lubricants should be available widely, and without charge. Targeted distribution of free condoms helps overcome the barriers associated with their cost and can help reinforce the social acceptability of condom use. Distribution of condoms and sex-education information by peers and outreach workers plays an important role, including in the street or party setting. It is important to consider the variety of condoms available to meet key population preferences, and their distribution, to ensure wide availability of condoms and lubricant and access to them in places where people engage in stimulant drug use and sex concurrently. For example, in the case of sex-onpremises venues or nightclubs, simply making condoms available in the usual places, such as toilets or at the bar, is often not sufficient to ensure that people have them to hand when they need them. Consultation with the beneficiaries is critical to ensure easy access. Similarly, to ensure access to condoms in prisons, strategies must be tailored to each prison, based on its architecture, regime and the movements of prisoners within the prison. Safer-sex education for people who use stimulant drugs should cover: • Promotion of condoms and lubricant use • Information on sexual transmission of HIV, hepatitis and STIs • Safe-sex negotiation strategies • Information on strategies to reduce risks of HIV transmission (sero-sorting and strategic positioning), including their limitations • Information on pre-exposure prophylaxis of HIV (PrEP) Further resources The four key population implementation guides (the IDUIT, MSMIT, SWIT and TRANSIT) provide useful general information on condoms, lubricants and safer sex programming for people who inject drugs, men who have sex with men, sex workers and transgender people. 23 Chapter 2 Core interventions 2.2 Needle and syringe programmes and other commodities Due to the short duration of their effects, injection of stimulant drugs is frequently associated with rapidly repeated injecting, with some individuals reporting more than 20 injections a day. Injecting may take place in groups, and people may use several different stimulant drugs and other types of drug in the same session. These patterns of use increase the likelihood that non-sterile equipment will be used or shared, elevating the risk of HIV and hepatitis transmission. The accessibility and design of needle and syringe programmes (NSPs) must take into account the nature of stimulant drugs and patterns of their use. People who inject stimulant drugs should be educated, encouraged and supported to acquire sufficient sterile syringes. NSP policies and protocols should allow people who inject stimulant drugs access to enough injecting equipment for themselves and their peers. One-for-one exchange or other forms of restricted access to needles and syringes are not recommended in any situation and are particularly unhelpful with people who inject stimulant drugs [85][86]. In the party and club scene, injecting stimulant drugs is more likely to take place outside the normal operating hours of HIV harm reduction services. NSPs and other community drug services do not always engage with the party and club scene, compounding the lack of service availability or HIV prevention messaging. This lack of access is particularly problematic for people who inject stimulant drugs, who would benefit from access to an NSP and other services. Creative strategies can be used to make sterile needles and syringes available to people who inject stimulant drugs, particularly outside operating hours, and in the places where stimulant drugs are purchased or used. These may include satellite NSPs in projects or clinics for key populations, needle and syringe dispensing machines, secondary NSP, outreach programmes, safer clubbing initiatives, outreach at sex-on-premises venues (bars, saunas, clubs, etc.), outreach programmes at festivals, and community mobilization initiatives. NSPs designed to address the needs of people who use stimulant drugs, including all key populations, are well positioned to provide an entry point to a coordinated cascade of services, starting with voluntary HTS. They can also offer information on how to reduce risks related to the use of drugs, distribute female and male condoms and lubricant, and provide route transition interventions (see below). Efforts to understand the context of an individual’s drug use, their injecting equipment needs, and their concurrent sexual behaviours will help ensure that appropriate messaging is used. NSPs should also provide education, advice and equipment to support safer injecting practices, including on the importance of hand hygiene, avoiding sharing any paraphernalia (filters, water) associated with injecting, and keeping even the smallest amounts of blood out of the space where drugs are prepared for injection. It is also important to provide syringe disposal bins or plastic bins or containers for the safe disposal of used injecting equipment, which is key to preventing needle-stick injuries and reducing risk or inconvenience to the wider community associated with illicit drug injection. Syringes with colour-coded barrels provide an example of a promising practice that supports people who inject stimulant drugs in group settings. Each participant is assigned a different colour and provided with syringes of that colour which he or she alone is to use. This can help reduce the accidental sharing of injecting equipment, particularly if it is reused. Route transition interventions Route transition interventions support people who use drugs to avoid initiation into injecting, or to encourage people who are injecting to transition to non-injecting routes of administration. Behavioural interventions, peer education interventions and the provision of commodities that support alternatives to injecting, such as pipes, mouthguards and aluminium foil, can be used to engage with people who inject heroin and/or stimulant drugs. Box 3. A harm reduction programme for people who smoke cocaine or methamphetamines in the Pacific North-West United States The People’s Harm Reduction Alliance (PHRA) is a peer-based harm reduction programme for people who use drugs in the Pacific North-West of the United States, established in 2007. In its first year, PHRA provided syringes and sterile injection equipment; however, the need to expand services to include people who smoke drugs became quickly apparent via the peer-based framework and feedback from clients. In 2008, PHRA launched a crack pipe programme to reach a different group of people who use drugs. The programme has become a point of contact for them to access additional services. In 2015, the programme was expanded to include methamphetamine pipes because participants informed PHRA that lack of access to pipes led them to inject more frequently than they would otherwise do. Both pipe programmes have increased the inclusion of people who smoke crack and methamphetamine at PHRA and linked them to other essential health services. In 2016, PHRA expanded services for non-injectors further with a snorting programme. HIV and HCV prevention opportunities for people who smoke stimulant drugs Crack cocaine, cocaine base and methamphetamine can be smoked in a pipe, offering access to the high-dose surging effect. The repeated use of heated crack pipes can cause blisters, cracking and sores on the tongue, lips, face, nostrils and fingers. It has been suggested that this may facilitate HCV transmission via unsterile paraphernalia (although this has not been clearly established). People smoking stimulant drugs in pipes do not require single-use equipment but will benefit from having personal (individual) smoking equipment, and messaging that pipes should not be shared. The same principle applies for straws used to inhale cocaine. The distribution of pipes, mouthguards and other piping paraphernalia provides practical strategies for engaging stimulant drug smokers and reinforces the “Don’t share pipes” message. The principles of distributing paraphernalia and engaging people who smoke stimulant drugs with messages about HIV and hepatitis prevention remain the same. 25 Chapter 2 Core interventions Box 4. Example of content of kits for safer smoking • Pipes • Mouth- or lip guards – a rubber band, rubber tubing, or sometimes specially produced • Stainless steel wool, used as gauze to suspend the crack cocaine inside the pipe • Alcohol wipes to clean the pipe and reduce risks associated with sharing • Lip balm containing vitamin E, to help protect and heal chapped or injured lips • Sterile dressing to cover wounds or burns arising from smoking crack • Sugar-free chewing gum which can help stimulate saliva production to protect teeth and reduce dental damage • Condoms and lubricants to support safer sex practices • Health promotion leaflets Safe tattooing In some population groups who use stimulant drugs, unsafe tattooing is frequent and constitutes a risk for transmission of HCV. This is a particular issue in prisons where tattooing is prohibited and hidden and unhygienic tattooing is common. NSPs and other low-threshold services can offer safe tattooing information, training and safe equipment. 2.3 HIV testing services HIV testing provides an opportunity to deliver HIV prevention messages and to link people to HIVprevention and other relevant health and support services. HIV testing services (HTS) are also the critical entry point to ART (see section 2.4). Given the evidence that individuals who are ARTadherent and have achieved viral suppression do not transmit HIV, HTS is a crucial component of HIV prevention programmes. It is important to increase the opportunities for people who use stimulant drugs to access and use confidential, easy and convenient HIV testing that is linked to the provision of ART for those who test positive. Community-based rapid HIV testing provides an opportunity to deliver results immediately. This can be of particular importance with street- or venue-based people who use stimulant drugs, where the primary source of engagement may be outreach programmes brought to where they are, rather than waiting for them to present at a specific testing location. Other outreach opportunities may also be used to distribute HIV self-test kits. Regardless of the testing modality, it is important to have a protocol to assist people to get a confirmatory test if they test positive, and to access and successfully use HIV care and treatment services if needed, including immediate access to ART, post-exposure prophylaxis (PEP) or PrEP, as appropriate. On-site HIV testing can pose challenges, including the possible lack of confidentiality that comes especially with small, closed communities. Outreach workers and service providers need to ensure that HIV testing is always voluntary and that coercive use of self-test kits by third parties such as law enforcement or employers to test any individual (e.g., sex workers) is unacceptable. 2.4 Antiretroviral therapy Antiretroviral therapy (ART) is the treatment of people living with HIV with medications that suppress the replication of the virus. Currently the standard treatment consists of a combination of antiretroviral drugs (ARVs), and it is indicated for all people living with HIV, irrespective of their CD4 count. ART reduces morbidity and mortality rates among people living with HIV, improves their quality of life and reduces risks of transmission of HIV. ARVs are also administered to some groups of people at risk for HIV acquisition either before exposure (PrEP) or after (PEP). ART is also needed for prevention of mother-to-child transmission of HIV. Cocaine and ATS have been associated with faster disease progression in people living with HIV, due to weakening of the immune system by the drugs. However, if adherence is maintained, the effectiveness of ART is not reduced in people who use stimulant drugs: ART reduces viral load and improves immune function, just as it does for other people living with HIV [77]. Strategies to support adherence to ART, including peer and outreach support, are described in section 3.1. Side-effects of antiretroviral drugs and interactions with stimulant drugs As with many medications, ARVs have been associated with various side-effects, including acute or chronic alterations of the renal function, or hepatic dysfunction. Some medications can cause sideeffects in the central nervous system, such as depression. Liver toxicity is one of the most commonly reported adverse consequences associated with ARVs. This can range from asymptomatic elevation of the liver enzymes to a hepatic failure. Risks for ARVrelated adverse consequences for the liver are higher in cases of cocaine use, excessive alcohol use, coinfection with HBV or HCV, fibrosis of the liver, concomitant treatment for TB and advanced age. Impact of stimulant drugs on antiretroviral drug serum level Cocaine, mephedrone and methamphetamines interact with several ARVs, influencing the serum level of the medications and the risk of side-effects. As scientific knowledge progresses, new ARV regimens may be proposed, with the potential for interactions with the NPS that are frequently appearing on the market. The University of Liverpool provides a regularly updated website on HIV medication interactions, including the interaction of ARVs with stimulant drugs: https://www.hiv-druginteractions.org/treatment_selectors. Impact of antiretroviral drugs on serum level of stimulant drugs Serum levels of methamphetamines may increase up to three times when used by someone who is also taking protease inhibitors, especially ritonavir. Fatal cases attributed to inhibition of the metabolism of MDMA and amphetamines by ritonavir have been reported. Oral pre-exposure prophylaxis Oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral medications to prevent the acquisition of HIV infection by uninfected persons. WHO recommends daily oral PrEP as a prevention choice for people at substantial risk of HIV [91]; it can be stopped during periods of low or no risk. Taken as prescribed, PrEP can reduce the risk of getting HIV from sex with an HIV-positive person by more than 90 per cent [92]. PrEP has been effective in communities where the primary vector for transmission is sexual, such as men who have sex with men, and is therefore appropriate for people who use stimulant drugs. PrEP does not replace HIV prevention interventions, such as comprehensive condom programming for sex workers and men who have sex with men. It does not prevent transmission of hepatitis and other STIs. Services for people who inject stimulant drugs should prioritize evidence-based comprehensive HIV prevention interventions, including NSP, condoms and lubricants. For men who have sex with men who use stimulant drugs and engage in high-risk sex, PrEP should always be proposed, whether or not the individual injects drugs. Adherence to PrEP is essential, and it may be challenging for people using stimulant drugs for several days in a row. People who use stimulant drugs and engage in concurrent sex should be encouraged and supported to plan ahead to use condoms, lubricants and PrEP in combination, to ensure better protection against HIV and to prevent other STIs, including hepatitis C and B. As with other prevention tools, the effectiveness of PrEP is optimized when interventions are implemented by, and in close consultation with, prospective beneficiary communities. Further resources Implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection (WHO, 2017) [93] Post-exposure prophylaxis Post-exposure prophylaxis (PEP) is the administration of ARVs for a short term (one month) to prevent HIV infection after exposure to HIV through unprotected sex or contact with blood. PEP should be offered to all individuals who have potentially been exposed to HIV, whether through unprotected sex (including sexual assault), needle-stick injury or sharing drug injection equipment. It should be initiated as early as possible, ideally within 72 hours. People who use stimulant drugs and engage in sex concurrently are known to often have multiple sexual partners. The chances of unprotected sex or condom failure are increased with stimulant drug use or with the increase in the number of partners. A participative stakeholder process should lead to the development of protocols for community access to PEP, from local to national levels, to ensure that the required medications are promptly accessible and are used by those who need them. People who use stimulant drugs and who access PEP regularly should be assessed as likely candidates for PrEP. Further resources Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] 2.5 Evidence-based psychosocial interventions and drug dependence treatments The impact of a drug is determined by the complex interactions between the substance, set (the mindset of the individual) and setting (the context), which mediate the drug’s effect and its associated impact on the individual, including the move towards dependent or high-risk drug use [94]. The great majority of people who use stimulant drugs do so on an occasional basis that may be characterized as “recreational”, and they will not develop dependence. This group has little need for high-intensity interventions. This section provides an overview of possible interventions, mainly psychosocial ones, that show effectiveness specifically for reducing risk behaviours and provide support for people who regularly use stimulant drugs, including people living with HIV. 29 Chapter 2 Core interventions The treatment of cocaine or ATS drug dependence requires time-intensive approaches that are not addressed here. Unlike the treatment of opioid dependence, there are currently no substitution medications available to treat dependence on cocaine or ATS [95][96]. Some emerging practices around dispensing dexamphetamine as a substitute for cocaine or methamphetamine dependence have shown early promise, but further research is needed. Behavioural interventions, self-regulation coaching and psychosocial counselling can support HIV/HCV prevention and treatment objectives for people who use stimulant drugs, while also contributing to longer-term and broader health and wellness goals. There is evidence that brief interventions that concentrate on providing information about safe behaviours and harm mitigation are effective in moderating drug-related harms [97] and maintaining ART adherence for those who are living with HIV [98]. Addressing the potential risks associated with the nexus of drug use and HIV requires individual, structural and combination approaches [99]. Psychosocial services such as motivational interviewing, brief interventions, contingency management and cognitive behavioural therapy are critical to effectively support HIV prevention and treatment among people who use stimulant drugs. Some of these approaches are described below. A 2016 review of psychosocial interventions for stimulant drug-use disorders found that all showed improved retention in ART compared with no intervention, although no single intervention showed a sustained benefit over the others [100]. Psychosocial services should be based on principles of community inclusion and participation, peer support and the needs of the individual. When developing HIV prevention interventions, it is important that sexual partners of people who use stimulant drugs be included in the process, focusing on the HIV risks that are associated with drug use and concurrent sexual behaviours. Motivational interviewing Motivational interviewing is a person-centred, semi-directive approach for exploring motivation and ambivalence in order to facilitate self-motivational statements and behavioural changes. It consists in establishing a partnership between the provider and the individual and enabling the individual to become aware of the discrepancy between their present situation and their own values. The technique relies on four principles: express empathy, develop discrepancy, roll with resistance and support selfefficacy. These can easily be used by trained non-specialist staff, including outreach workers, in formal or informal counselling, IEC and other conversations. Motivational interviewing generally requires just one or two sessions. The success of motivational interviewing has led to its implementation as a “catch-all” approach to eliciting change in areas such as medication compliance, smoking cessation and diet and exercise [101]. A 2012 Cochrane review suggested that motivational interviewing could reduce risky sexual behaviour, and in the short term lead to a reduction of viral load in young people living with HIV [102]. Research has shown that motivational interviewing can reduce the incidence of unprotected anal intercourse among men who have sex with men [103], as well as levels of drug use [104]. Brief interventions Brief interventions are short, often opportunistic interactions in which a health worker provides targeted information and advice to individuals during other activities such as distributing sterile injecting equipment or conducting an HIV test. Brief interventions have been shown to reduce drug use as well as associated risks and sexual risk behaviours. Meta-analyses suggest that there is little difference in the outcomes between longer, more intensive interventions and brief interventions, and the latter are likely to be more practical and cost-effective options, with few barriers to implementation [105]. Motivational interviewing, contingency management and brief interventions for dependence to stimulant drugs can reduce drug-related high-risk sexual behaviours and increase adherence to ART and PrEP. 30 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Contingency management Contingency management is an approach that incentivizes people with rewards such as cash that are contingent on achieving a set of pre-defined outcomes. Contingency management has been shown to have a moderate yet consistent effect on drug use across different classes of drugs [106]. The effectiveness of contingency management supports the idea that small, regular rewards motivate people to modify behaviours that could be considered harmful. Positive regard, and the client’s own expressed belief in their ability to achieve goals, are a critical factor in improving agreed-upon outcomes. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) is a structured approach to counselling that assumes that behaviours are learned and reinforced as a result of cognitive constructs and deficits in coping. The aim of CBT is to “unlearn” behaviours considered unhelpful, such as HIV risk behaviour or certain patterns of drug-taking. While results appear to be sustained over a period, CBT is intensive and time-consuming, and demands specialist practitioners and individual treatment [107]. Mindfulness Mindfulness can be defined as the ability to focus open, non-judgemental attention on the full experience of internal and external phenomena, moment by moment. Positive outcomes – including reducing drug use and risk behaviours, and in relapse prevention – have been documented from mindfulness training as part of approaches to reduce harm, including for people who use stimulant drugs [108][109][110]. Opioid substitution therapy and stimulant drug use People receiving opioid substitution therapy (OST) for heroin or other opioid dependence may use stimulant drugs because of OST-triggered fatigue, inability to experience pleasure, or the desire to remain connected to the community of people who use drugs. OST is not designed to counter stimulant drug use, and the concurrent use of stimulant drugs while on OST should not be viewed as a breach, nor should it lead to the reduction or discontinuation of OST. The benefits of OST are independent of stimulant drug use [111]. Existing OST providers should be sensitized to this and trained to use the opportunities afforded by regular OST and client engagement to support the delivery of interventions included in this guidance. Further resources mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings (WHO, 2010) [112] Therapeutic interventions for users of amphetamine-type stimulants (WHO, 2011) [113] Harm reduction and brief interventions for ATS users (WHO, 2011) [114] Guidelines for the management of methamphetamine use disorders in Myanmar (Ministry of Health and Sports, Myanmar, 2017) [115] Guidance for working with cocaine and crack users in primary care (Royal College of General Practitioners, 2004) [116] Principles of drug dependence treatment (UNODC, WHO, 2008) [117] Drug abuse treatment and rehabilitation: a practical planning and implementation guide (UNODC, 2003) [118] TREATNET quality standards for drug dependence treatment and care services (UNODC, 2012) [111] Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (WHO, 2009)[163] Treatment of stimulant use disorders: current practices and promising perspectives. Discussion paper (UNODC, 2019)[164] 31 Chapter 2 Core interventions 2.6 Prevention, diagnosis and treatment of sexually transmitted infections, hepatitis and tuberculosis Screening people who use stimulant drugs for infectious diseases, such as sexually transmitted infections (STIs), HBV, HCV and TB, is a crucial part of a comprehensive approach. Along with HIV, these infections are often associated with the use of illicit substances, and they may co-occur with stimulant drug use. Prevention, diagnosis and treatment of sexually transmitted infections Unsafe sex can lead to acute STIs, which can cause infertility and severe illness. Several STIs, particularly those involving genital or perianal ulcers, may facilitate the sexual transmission of HIV infection. Sex workers, transgender people and men who have sex with men are often at increased risk of STIs such as syphilis, gonorrhoea, chlamydia and herpes. It is therefore important to offer information, male and female condoms and lubricant, and screening, diagnosis and treatment of STIs and possibly HPV vaccine to people using stimulant drugs who are vulnerable to STIs and HIV. Further resources Resources on sexually transmitted and reproductive tract infections (WHO webpage providing clinical, policy and programmatic, monitoring and evaluation and advocacy guides) [119] Prevention, vaccination, diagnosis and treatment of hepatitis B and C People who inject stimulant drugs are at heightened risk of acquiring HBV and HCV because of frequent injecting and sharing of injection equipment. The risk of sharing equipment is higher when injecting happens in communal settings. HCV is much more virulent than HIV and can survive outside the body at room temperature, on environmental surfaces, for up to three weeks [120], making it more easily transmitted through the sharing of syringes and other injecting paraphernalia. Key populations who use stimulant drugs should be offered hepatitis B or hepatitis A-B vaccination, access to prevention commodities, and voluntary screening and treatment of HBV and HCV. Prevention NSPs and community mobilization initiatives should distribute relevant equipment, including low dead-space syringes, for injecting, smoking and snorting (see section 2.2). Male and female condom programming is also part of hepatitis B and C prevention interventions as well as sexual and reproductive health services. Education should include messages on the risks of serosorting, and of intense sexual practices involving potential trauma of the mucosa for HCV acquisition and transmission among people living with HIV [50]. Hepatitis A and B vaccination Key populations should be offered the series of HBV immunizations. WHO recommends: • Offering people the rapid hepatitis B vaccination regimen (days 0, 7 and 21-30). • Providing people who inject drugs with incentives in order to increase hepatitis B vaccination adherence, at least for the second dose. Even partial immunization confers some immunoprotection. [87] Hepatitis A (HAV) immunization or combined HAV-HBV immunization should be offered to men who have sex with men and people using stimulant drugs [121]. 32 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Immunization should be easily accessible and offered at locations and venues frequented by people who use stimulant drugs, such as drop-in centres, NSPs and other community service outlets. Screening for HBV and HCV Voluntary screening for HBV and/or HCV should be offered to people who use stimulant drugs at risk of these infections. Testing and diagnosis of HBV and HCV infection is an entry point for accessing both prevention and treatment services. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay the progression of liver disease. Rapid tests for hepatitis C allow for better access to diagnosis, including communitybased testing. Treatment of chronic hepatitis C or B All people with chronic hepatitis C should receive treatment. With an 8- to 12-week course, directacting antivirals (DAAs) cure more than 95 per cent of persons with HCV infection, reducing the risk of death from liver cancer and cirrhosis. For chronic hepatitis B, antiviral treatment can slow down the progression of cirrhosis and reduces the risk of liver cancer [162]. People who are actively injecting drugs have been shown to adhere to HCV treatment regimens as well as any other population, particularly when social, emotional and practical support are provided [122]. All people who use stimulant drugs living with HCV should therefore be offered access to direct-acting antivirals without discrimination. Further resources Guidance on prevention of viral hepatitis B and C among people who inject drugs (WHO, 2012) [87] Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection (WHO, 2016) [123] Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] Prevention, diagnosis and treatment of tuberculosis In 2016, 10.4 million people fell ill with TB. It is a leading killer of people living with HIV: in 2016, 40 per cent of HIV deaths were due to TB [124]. Transmission of TB is easily facilitated through airborne particulates, such as by kissing, coughing, sneezing or shouting. TB is easily spread in prisons and other closed settings, and in crowded and poorly ventilated spaces, such as are often found in poor communities or among homeless people. People who inject drugs are at increased risk of TB, irrespective of their HIV status, and TB is a leading cause of mortality among people who inject drugs who also have HIV infection [125]. People who use drugs who do not inject have also been found to have increased rates of TB. Certain subgroups of stimulant drug users, such as those who use stimulant drugs regularly for days at a time, may be immuno-deficient from lack of sleep and food, facilitating TB transmission. It is therefore important to include TB prevention, screening and treatment in communities and services. Further resources Integrating collaborative TB and HIV services within a comprehensive package of care for people who inject drugs: consolidated guidelines (WHO, 2016) [125] 33 Chapter 2 Core interventions 2.7 Targeted information, education and communication To reduce the risk of acquiring STIs or HIV, people who use stimulant drugs need knowledge and support. Information, education and communication (IEC) provides information, motivation, education and skills-building to help individuals adopt behaviours that will protect their health. Effective communication for health targeting people who use stimulant drugs requires addressing two challenges: • Crafting messages that can overcome long-standing distrust and fear. • Finding effective means of reaching people who use stimulant drugs with life-saving messages and materials. Key to meeting these challenges is meaningful engagement with the target audience of people who use stimulant drugs. Communities should be represented at every stage of IEC development, including the overall strategy and concept, and the development, testing, dissemination and evaluation of messages. Working with the community will help ensure that tools and materials are accurate and will be trusted and used. Recipients of IEC who have invested their own ideas and time in it will be more likely to stand behind the results and be active participants, not only in their own health but in health promotion in their community. Materials must be easily understandable and to the point. Interactive materials on a digital platform can tailor messaging to the specific situation of the service user and are often helpful in maintaining attention. On the other hand, traditional printed materials have the advantage of not requiring computer, phone or Internet access. They also provide an opportunity for outreach workers or other programme staff distributing the materials to interact with the service users, and a means for service users to easily share information with others. Using information technology to support behavioural interventions Online and social media can be a cost-effective manner of reaching targeted audiences. A local assessment can show where using these technologies will be advantageous and appropriate. Free WiFi at drop-in centres and other community points of congregation provides opportunities for access and use. Where people who use stimulant drugs have smartphones, websites and apps can be deployed just as they have been to reach other key populations. The use of technology has shown promising results in promoting sexual health or adherence to ART in different settings, including resource-limited settings [126][127]. Web-based applications provide an opportunity to reach a large audience at any time and provide information on health and available services. They also allow for online outreach and interactions with people who wish to discuss problems or have questions. However, when the information relates to drug use, or other criminalized behaviours, the use of some digital media raises concerns about the anonymity of the contacts, and possible risks related to law enforcement must be addressed. Working with communities and low-threshold service providers will help inform the local potential for digital materials and campaigns and help ensure the security of people accessing information. Given the variety that exists among people who use stimulant drugs, messaging should take into account the sex, gender, sexual orientation, age and setting of recipients of IEC. Literacy levels, social and community inclusion or exclusion, and other cultural and societal variables must also be considered. 34 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Further resources The European Centre for Disease Prevention and Control (ECDC) has developed guidance documents for the effective use of social media. While the tools were developed for Europe, and specifically for reaching men who have sex with men, they provide guidance on the relative advantages of different media, such as Facebook, online outreach, Google Ads, SMS and YouTube, that may be useful in other contexts. Effective use of digital platforms for HIV prevention among men who have sex with men in the European Union/European Economic Area: an introduction to the ECDC guides (ECDC, 2017) [128] 2.8 Overdose and acute intoxication prevention and management Very high doses of stimulant drugs consumed in a short amount of time can trigger acute respiratory distress, chest pain, palpitations or myocardial infarctions [112]. In extreme cases this can result in cardiac arrest. The first signs of stimulant drugs intoxication are hyperactivity, rapid speech and dilated pupils. In the case of polydrug use, overdose can be the result of the combination of stimulants with other drugs including opioid or sedative drugs. The treatment of stimulant drugs intoxication is symptomatic and requires regular monitoring of blood pressure, pulse rate, respiratory rate and temperature (figure I.). Serotonergic syndrome is caused by an excess of serotonin in the central nervous system associated with the use of ATS. It can result in uncontrollable muscle spasms, tremor, seizures, psychosis, high blood pressure, high body temperature >400 C (hyperthermia) and release of myoglobin from muscles and blood clotting in vessels (disseminated intravascular coagulation), which may lead to severe diseases and potentially death. People who use stimulant drugs need to be informed on how to reduce the risks of acute intoxications (see the Information checklist for self-care and stimulant drugs in the annex). For people on PrEP, ART or hepatitis treatment, information should be provided on the interactions and possible risks of cocaine and ATS use to serum levels (see section 2.4). People who use stimulant drugs should be trained to recognize overdoses, provide first aid, including cardiopulmonary resuscitation (CPR) and call immediately for emergency professional assistance if they witness an overdose. Please do not use any other resources to answer the question other than the information I provide you. If you cannot answer with only the information I provide say "I cannot answer without further research." What are the key considerations and strategies for people who use stimulant drugs and engage in concurrent sex in terms of HIV prevention, and how does the effectiveness of these strategies get optimized?
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Please do not use any other resources to answer the question other than the information I provide you. If you cannot answer with only the information I provide say "I cannot answer without further research."
EVIDENCE:
Purpose of this guide The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses. It aims to: • Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations • Provide implementation guidance to help establish and expand access to core HIV and hepatitis prevention, treatment, care and support services It is a global document that should be adapted according to the specific context, including the type of stimulant drug used (cocaine, ATS or NPS) and the key populations involved, which vary considerably according to regions. The present guide proposes a package of core interventions adapted from existing international guidance: • WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users[7] • WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations – 2016 update [8] • Implementing comprehensive HIV and HCV programmes with people who inject drugs: practical guidance for collaborative interventions (the “IDUIT”) [9] It also incorporates guidance from the implementation tools for other key populations: • Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions (the “SWIT”) [10] • Implementing comprehensive HIV and STI programmes with men who have sex with men: practical guidance for collaborative interventions (the “MSMIT”) [11] • Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions (the “TRANSIT”) [12] However, none of these guidance documents and tools addresses the specific needs of people who use stimulant drugs and are at risk for HIV and hepatitis B and C – hence the need for this publication. Audience The guide is intended for use by policymakers, programme managers and service providers, including community-based organizations, at the national, regional or local levels, who undertake to address HIV prevention, treatment and care. It also provides useful information for development and funding agencies and for academia. Structure The guide is divided into five chapters. • Chapter 1 explains the nature and effects of stimulant drugs, the associated risks of HIV and hepatitis transmission, and the issues surrounding stimulant drug use and HIV and hepatitis risk in specific key populations and other vulnerable groups. 10 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Chapter 2 presents the package of core HIV interventions for key populations who use stimulant drugs. • Chapter 3 describes approaches to care and support for people who use stimulant drugs, particularly in the context of HIV and hepatitis. • Chapter 4 describes six critical enablers – activities and strategies that are needed to ensure access to the interventions in the core package. • Chapter 5 outlines further considerations for implementing programmes. Within each chapter, further resources are listed. Case studies are provided throughout the guide to illustrate specific aspects of programmes that have been implemented in different countries. There is also an annex presenting a series of checklists and other practical tools for policymakers and implementers. Principles Two important overarching principles are stressed throughout this publication. The first is better integration of HIV, hepatitis B and C and sexually transmitted infection (STI) services for people who use stimulant drugs within existing HIV harm reduction services2 and drug treatment services for people who inject drugs, and within sexual and reproductive health and other HIV services for key populations. The second is the meaningful involvement of people who use stimulant drugs, people living with HIV and other key populations in planning, implementing, monitoring and evaluating interventions. This is key to their success and sustainability. Finally, the implementation of HIV-related services for people who use stimulant drugs should adhere to human-rights principles as described in the implementation tools mentioned above – the SWIT, MSMIT, TRANSIT and IDUIT. Methodology In its June 2009 session, the UNAIDS Programme Coordinating Board (PCB) called upon “Member States, civil society organizations and UNAIDS to increase attention on certain groups of non-injecting drug users, especially those who use crack cocaine and ATS, who have been found to have increased risk of contracting HIV through high-risk sexual practices”. UNODC therefore commissioned a review and organized a Global Expert Group Technical Meeting on Stimulant Drugs and HIV, held in Brazil in 2010. A discussion paper on HIV prevention, treatment and care among people who use (noninjecting) crack and cocaine or other stimulant drugs, particularly ATS, was developed in 2012. In 2013 the UNODC HIV Civil Society Organization (CSO) group established a Stimulant Drugs and HIV working group, with representatives from civil society and experts on HIV and stimulant drugs. The group organized consultations with representatives of the community and CSOs, including on the margins of the International Harm Reduction Conference in Kuala Lumpur in 2015. 2 For the purposes of this guide, harm reduction is defined by the nine interventions of the “comprehensive package” of services detailed in the WHO, UNODC, UNAIDS Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (see citation 7). These are: 1. Needle and syringe programmes; 2. Opioid substitution therapy and other drug dependence treatment; 3. HIV testing and counselling; 4. Antiretroviral therapy; 5. Prevention and treatment of sexually transmitted infections; 6. Condom programmes for people who inject drugs and their sexual partners; 7. Targeted information, education and communication; 8. Prevention, vaccination, diagnosis and treatment for viral hepatitis; 9. Prevention, diagnosis and treatment of tuberculosis. 11 In December 2014, the Strategic Advisory Group to the United Nations on HIV and injecting drug use, consisting of representatives of networks and organizations of people who use drugs, academics, donors, implementers and United Nations organizations, recommended conducting a new literature review on stimulant drugs and HIV and hepatitis C. In 2015 UNODC, together with WHO and UNAIDS, defined the scope of this new literature review, and accordingly UNODC commissioned it to cover the extent, patterns and geographic distribution of injecting and non-injecting stimulant drug use (particularly crack, cocaine, ATS and stimulant NPS) in men who have sex with men, sex workers and other groups of stimulant drug users, and their possible link to HIV and hepatitis B and C vulnerability and transmission; and effective interventions for prevention, treatment and care of HIV and hepatitis B and C among people who use such stimulant drugs. The results of the literature review were published by UNODC in 2016 in five papers covering the following topics: • Methodology and summary [3] • ATS [13] • Cocaine and crack cocaine [14] • NPS [15] • Treatment and prevention of HIV, HCV & HBV among stimulant drug users[16]. Subsequently, in the framework of preparations for the United Nations General Assembly Special Session on the World Drug Problem (UNGASS 2016) and the HLM 2016, UNODC organized a scientific consultation on HIV and drug use, including stimulant drugs. The papers relating to stimulant drugs presented at the Commission on Narcotic Drugs in March 2016 covered: cocaine and crack cocaine use and HIV in the United States; ATS and men who have sex with men in Asia; and antiretroviral therapy (ART) and stimulant drug use. The recommendations of the contributing scientists were summarized as part of a scientific statement presented in New York on the margins of the UNGASS 2016 and the HLM 2016 [17]. The statement stressed the need to address HIV among people who use stimulant drugs, including the structural, social and personal mediating factors for HIV transmission, such as polydrug use, STIs, mental health, homophobia, discrimination and punitive laws. The scientists recommended the provision of ART to all people using stimulant drugs living with HIV, and the implementation of new prevention tools such as pre-exposure prophylaxis (PrEP) and the use of social media for communication. The statement also emphasizes that with proper support for adherence, ART is effective among people living with HIV who use stimulant drugs. In 2017, UNODC commissioned the development of the present publication, HIV prevention, treatment, care and support for people who use stimulant drugs: an implementation guide. Based on the results of the scientific reviews and of the expert group meetings, and on international guidance and country practices that have been identified as effective in meeting the needs of people who use stimulant drugs, a first draft of the document was developed under the guidance of the UNODC CSO Stimulant Drugs and HIV working group. The draft guide was reviewed by external peer reviewers, United Nations agency reviewers and community representatives through an electronic consultation and three face-to-face consultations held in Viet Nam (2017), Brazil (2017) and Ukraine (2018). Chapter 1 Stimulant drugs, HIV and hepatitis, and key populations The World Drug Report 2019 estimates that about 29 million people used ATS in 2017, and 18 million used cocaine [18]. There is no estimate of the total number of people using NPS. The great majority of people who use stimulant drugs do so on an occasional basis which may be characterized as “recreational”, and they will not develop dependence or any other health problem. There is evidence that the prevalence of ATS use, particularly methamphetamines, is increasing in some regions, including North America, Oceania and most parts of Asia. In addition, between 2009 and 2016, there were reports of 739 NPS, of which 36 per cent were classified as stimulant drugs [19]. Only a small proportion of people who use stimulant drugs inject them; most smoke, snort or use them orally or anally. However, the World Drug Report 2017 states that 30 per cent of people who inject drugs inject stimulant drugs, either as their drug of first choice or in addition to opiates. Despite evidence showing that certain subgroups of people who use stimulant drugs are at greater risk of HIV, prevention, testing and treatment programmes for these population groups remain very limited in scope and scale across the globe, and their specific needs are often overlooked. 1.1 Stimulant drugs Stimulant drugs are chemically diverse substances that are similar in their capacity to activate, increase or enhance the neural activity of the central nervous system, resulting in a common set of effects in most people who use them, including increased alertness, energy and/or euphoria.3 This publication considers three types of stimulant drugs for which data have shown a link with increased HIV risk among some key populations: • Cocaine: Found in various forms, e.g. smokable cocaine, crack cocaine, freebase, paste or pasta base, paco, basuco. Depending on the form, it may be sniffed or snorted, injected, ingested or inserted anally. 3 For more detailed information on different stimulant drugs and their effects, see: Terminology and information on drugs. Third edition. New York (NY), United Nations, 2016 (https://www.unodc.org/documents/scientific/Terminology_and_ Information_on_Drugs-3rd_edition.pdf, accessed 15 January 2019). 14 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Amphetamine-type stimulants: Amphetamines and methamphetamines (excluding MDMA) are found in different forms, e.g. crystals (methamphetamines), powder or formulated tablets [20]. They are taken orally, smoked from a pipe, sniffed or snorted, inserted anally or injected in a solution. • Stimulant new psychoactive substances: Found in various forms, e.g.synthetic cathinone, phenethylamines, aminoindanes and piperazines. They are sometimes referred to as “bath salts” [21][22]. Depending on the form, NPS are taken orally, smoked, inserted anally or injected. All types of stimulant drugs have common effects: • Mental: Euphoria, raised libido, reduced appetite and sleep drives, enhanced perception, increased alertness, cognitive improvements and deficits (attention, working memory, long-term memory), emotional intensity and excitability, and increased confidence. • Behavioural: Talkativeness, hypervigilance, hyperactivity, increased sociability, disinhibition, changes in sexual behaviour (including sexual sessions of longer than usual duration), faster reaction, and repetitive activity (“tweaking”); hyper-excitability, insomnia, restlessness, panic, erratic behaviour, and sometimes aggressive or violent behaviour[23]. • Physical: Increased heart rate (including palpitations), raised temperature (hyperthermia), circulatory changes (higher blood pressure, vasoconstriction), increased breathing rate, dry mouth, teeth-grinding, jaw-clenching/gurning, faster eye-movements, and dilated pupils. The onset and duration of these effects vary according to the drug, its form, dosage, route of administration, the characteristics of the individual using it, and the context of use. Chronic use of stimulant drugs can lead to psychological dependence; development of tolerance; destruction of tissues in the nose if snorted or sniffed; chronic bronchitis, which can lead to chronic obstructive pulmonary disease; malnutrition and weight loss; disorientation, apathy, confusion, exhaustion due to lack of sleep, and paranoid psychosis. During withdrawal there may be a long period of sleep and depression. Cocaine Cocaine is generally encountered in two forms which differ in their route of administration: cocaine hydrochloride (HCL), a powder, which is snorted, injected or taken anally, and cocaine base (crack, freebase, or crystal) which is smokable and usually taken in a pipe. A third form, coca paste (pasta base, paco, coca pasta, etc.), is an intermediate product of the process of extraction of HCL from the coca leaves. Available mainly in Latin America, it is usually smoked in a cigarette. Cocaine is a powerful stimulant whose effects diminish quickly, prompting the user to repeatedly administer additional doses. When snorted, cocaine produces a slow wave of euphoria, followed by a plateau and then a “come down” period. In its smokable form, cocaine has a more intense and immediate effect. Severe anticipatory anxiety about the impending low may result in repeat dosing. This cycle may take around 5 to 10 minutes. The use of cocaine is more prevalent in North and South America than in the rest of the world. Amphetamine-type stimulants (ATS) Amphetamine and methamphetamine are synthetic drugs whose effects include euphoria, arousal and psychomotor activation. ATS can be taken orally, intranasally, smoked as a vapour (pipe), inserted anally or injected. Immediately after smoking or injecting, people experience a pleasurable “rush”. Intranasal and oral ingestion produce a gradual euphoria or “come up”. Depending on the level of tolerance, the effects of methamphetamine may last four hours, or as long as 24 hours for someone new to the drug [24]. Some people who use methamphetamine may experience a feeling of invincibility, with an accompanying propensity to engage in high-risk behaviours, creating vulnerabilities to acquiring HIV [25]. The direct health impacts of ATS include insomnia and cardiovascular stress. Long-term negative effects may include dopamine physical dependence, psychological dependence, psychosis and paranoia, and depression. Amphetamine and methamphetamine use is reported in all parts of the world. Stimulant new psychoactive substances There are a various types of new psychoactive substances (NPS), with different molecular structures, but the majority of stimulant NPS are synthetic cathinones, which have a similar molecular structure to cathinone found in the khat plant. Common synthetic cathinones include mephedrone, pentedrone, methylone or methcathinone. They fall into two main families: euphoriants and entactogens.NPS are taken orally, can also be snorted or inserted anally, and less frequently are injected. Stimulant NPS produce similar mental, physical and behavioural effects to traditional stimulant drugs such as cocaine, amphetamines and methamphetamines. Synthetic cathinones and other stimulant NPS are also used to improve sexual experience [26]. The use of synthetic cathinone such as mephedrone (sometimes called “bath salts”) has recently emerged [18]. Studies from Hungary [27][28][29], Ireland [30][31], Israel [32], Romania [33] and the United Kingdom [34] suggest that due to a shortage in heroin supply and easy access to synthetic cathinone, a significant proportion of people who inject drugs have switched to injecting synthetic cathinone in recent years. 1.2 Stimulant drug use and risks of HIV/HBV/HCV transmission The HIV/HBV/HCV risk associated with stimulant drug use is linked to a higher prevalence of unprotected anal and vaginal sex, and of sharing pipes, straws and injection equipment, in some groups of men who have sex with men, sex workers, people who inject drugs and people in prisons. Transmission risks through concurrent stimulant drug use and unprotected sex Inconsistent condom use by people who use stimulant drugs has been identified as a prime means of contracting STIs, including HIV, particularly as a result of the concurrent use of stimulant drugs with frequent sexual activity of long duration with multiple partners or in groups. Stimulant drug use may also facilitate longer penetration (which can lead to condom breakages), and more intense acts such as fisting that increase the opportunity of anal and vaginal tears or bleeding. Transmission risks through sharing injection equipment Injecting methamphetamine, cocaine or NPS entails a similar risk to injecting other drugs when needles and injecting equipment are shared. Given that many stimulant drugs have a shorter duration of action compared with opioids, people who inject stimulant drugs report a higher frequency of injecting, with compulsive re-injecting and a greater likelihood of sharing and reusing needles and syringes that may be contaminated [22][34]. HIV and HCV risk is also increased when cocaine or crack is coadministered with heroin, including injection of heroin and cocaine (“speedballing”) [35]. Coexisting injecting drug use and unprotected sex further increases the likelihood of HIV and hepatitis transmission, especially in high-incidence communities. This pattern has been seen, for example, with the use of home-made ATS, such as boltushka in Ukraine. People who inject boltushka engage in high levels of injecting risk behaviours and in sexual risk behaviour post use. They are young and poor, and the great majority are already living with HIV [36]. Hepatitis C transmission through straws or pipes HCV is transmitted through blood or, less commonly, through sexual contact. HCV can be transmitted from a person living with hepatitis who has oral or nasal sores or lacerations through sharing of straws or pipes [37][38][39][40]. Compared with the general population, higher HCV prevalence rates, ranging from 2.3 to 17 per cent, have been observed among people who smoke or sniff stimulant drugs [41]. However, it is difficult to determine whether HCV transmission in these cases occurred through blood exposure, sexual activity, or both. 1.3 Stimulant drug use and HIV/HBV/HCV transmission risks among key populations Men who have sex with men There seems to be a clear association between ATS use among men who have sex with men and risk of HIV infection. Methamphetamine use has been associated with increased frequency of unprotected sex among some men who have sex with men, thereby increasing vulnerability to STIs, HBV and HIV [42][43][44][45]. Studies have indicated HIV prevalence rates among men who have sex with men who use methamphetamine ranging between 17 and 61 per cent, and HIV incidence ranging from 2.71 per 100 person-years [46] to 5 per 100 person-years [47]. The use of stimulant drugs by some men who have sex with men to facilitate sex (referred to as ChemSex)4 has been linked to decreased condom use, sex with multiple partners and other high-risk sexual behaviours that increase likelihood of HIV and HCV transmission [48][49]. Increased sexual risk behaviours, including unprotected sex, coupled with potential anal or rectal trauma resulting from longer, more frequent and intense sexual encounters under the influence of drugs, could facilitate STI transmission among men who have sex with men, including HCV among men who have sex with men living with HIV. Risk-reduction strategies for HIV prevention such as serosorting5 and strategic positioning6 are inefficient for the prevention of other STIs, HBV or HCV. The association between ChemSex, drug use and sexually transmitted acute HCV infection among men living with HIV who have sex with men has been documented in several countries and regions [50]. ChemSex is mostly associated with non-injecting drug use, although some may also inject synthetic cathinones, amphetamines and methamphetamines (referred to as “slamming” or “blasting” within the context of ChemSex) [51], with a high level of sharing of injection equipment and consequently higher risks of HIV and HCV transmission [52][53][54]. Mephedrone use seems to have risen among men who have sex with men in the context of ChemSex [52]. The use of erectile dysfunction medications such as sildenafil is often reported among men who have sex with men who also consume methamphetamines and has been identified as increasing rates of unprotected sex and HBV, syphilis and HIV risks [46][48][55]. People who inject drugs Injecting stimulant drugs carries the greatest risk of acquiring HCV or HIV, due primarily to the sharing of contaminated needles and syringes. People who inject cocaine, ATS or heroin have a risk of acquiring HIV that is respectively 3.6, 3.0, and 2.8 times greater than people using stimulant drugs without injecting [56]. Outbreaks of HIV or hepatitis C among people who inject drugs, partly due to the increased use of synthetic cathinone as a replacement for heroin, have been reported in Greece [57], Hungary [29] and Romania [33][58]. People who inject stimulant drugs such as ATS show higher prevalence of sexual risk behaviours compared with people who inject opiates, and similar to non-injecting ATS users [59][60][61][62]. Sex workers Exchanging sex for crack cocaine or money has been associated with several HIV risk behaviours, such as having a greater number of clients per week [63], high levels of unprotected sex [64], sharing crack cocaine with clients [65] and heavier crack use, as well as structural vulnerabilities like homelessness and unemployment [66]. One study reported a higher HIV prevalence among those who exchange sex for drugs or money than among those who did not [67]. Individuals with drug dependencies who exchange sex for drugs may have reduced power and control over sexual interactions [68]. The use of methamphetamines by female sex workers has been associated with engaging in unsafe sex [69]. Female sex workers who use smokable cocaine are often homeless or poorly housed in economically depressed neighbourhoods, and have poor access to health services, including HIV services, as well as to prenatal and reproductive care and to social support. Sex workers, whether male, female or transgender, may be coerced into consuming drugs with their clients, increasing the risk of unprotected sex and violence. Male, female and transgender sex workers face barriers to accessing and using services due to the multiple stigma surrounding drug use, sex work and sexual orientation, which are criminalized to varying degrees in many jurisdictions around the world. Transgender people The use of methamphetamines, smokable cocaine or cocaine among transgender women has been associated with higher risks of HIV transmission, mainly through sex [70][71]. For example, a survey conducted among transgender women in high-risk venues and on the streets of Los Angeles, United States, indicated that recent methamphetamine and/or smokable cocaine use was associated with a more than twofold higher risk of reported HIV-positive status [72]. People living in prisons and other closed settings People who use stimulant drugs, such as methamphetamine, in prisons are more likely to engage in a number of sexual risk behaviours, including use of methamphetamines in the context of sex and inconsistent use of condoms [73][74]. 18 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Women who use drugs Women who use drugs face stigma and other barriers to accessing essential health and HIV services, including gender-based violence, fear of forced or coerced sterilization or abortion, or loss of child custody. Cross-cultural stigma associated with women vacating gender roles, such as caring for their family, being pregnant and being mothers of infants and children, is a major challenge [75]. Many women who use drugs face unequal power dynamics in relationships, and higher rates of poverty; these factors interfere with their ability to access reproductive health supplies, including condoms and other contraceptives [76]. People living with HIV Although cocaine or methamphetamine use has a negative impact on the immune system, particularly among people living with HIV, the immunodepressive effect disappears when people living with HIV who use stimulant drugs adhere to antiretroviral therapy [77]. People living with HIV using stimulant drugs experience the worst HIV outcomes when they do not know they are living with HIV, or cannot access ART. A review of the literature reports findings that psychological, behavioural and social factors all play a role, separately and in combination, in determining HIV outcomes in patients, their access to health services, and adherence to ART: • In people living with HIV, regular methamphetamine use has measurable negative effects upon neuropsychological functioning (e.g. deficits in episodic memory, executive functions and information-processing speed) [78] over and above the negative neurocognitive effects caused by HIV and HCV [79]. This may impact their health-protective behaviour, health-services-seeking, access to HIV clinics and adherence to ART. In addition, HIV-specific traumatic stress and related negative affect are independently associated with greater stimulant-drug risk behaviours and reduced ART adherence [80]. • Cocaine and ATS have a negative impact on the immune system, increasing vulnerability to opportunistic diseases and accelerating the evolution of HIV among people who do not adhere to ART [77][81]. (See section 2.4 for more information on the interactions between ART and stimulant drugs). • Some communities of people who use stimulant drugs are very marginalized, extremely poor and have few resources, including access to adequate nutrition, and this also impacts their access to services and consequently the evolution of HIV infection. To reach people who frequently use stimulant drugs and retain them in effective HIV treatment regimes, access and adherence barriers related to HIV treatment must be accurately identified and addressed. When assessing why a patient who uses stimulant drugs is lost to follow-up, important factors that should be considered include stigma, discrimination, mental health, employment status, poverty, homelessness, migration, exposure to violence, incarceration, fear of criminalization, and family responsibilities. See chapter 4 for more information. 1.4 The impact of criminal sanctions on HIV transmission among key populations Stigma, discrimination and criminal sanctions against people who use drugs, men who have sex with men, transgender people, sex workers and people living with HIV have a direct impact on their ability and willingness to access and use HIV and other health services. These also impede the ability of people from key populations to access the commodities or services needed to practise protective behaviours, including condom use, and to access sterile injecting equipment, HIV testing and HIV treatment. A systematic review of 106 peer-reviewed studies published between 2006 and 2014 examined the association between criminal sanctions for drug use and HIV prevention and treatment-related outcomes among people who inject drugs [82]. While the studies were mainly conducted in North America and Asia, the findings highlighted that criminal sanctions were responsible for substantial barriers to HIV treatment and prevention interventions for people who inject drugs. 21 Chapter 2 Core interventions Following an extensive literature review and technical consultations at country and global levels, expert participants in a number of consultations agreed on a package of eight core interventions for HIV prevention, treatment, care and support among people who use stimulant drugs and are at risk of HIV. These interventions have been adapted from the WHO/UNODC/UNAIDS Comprehensive Package for HIV and people who inject drugs, and from the WHO Consolidated Package for HIV and key populations [7][8]. 1 Condoms, lubricants and safer sex programmes 2 Needle and syringe programmes (NSP) and other commodities 3 HIV testing services (HTS) 4 Antiretroviral therapy (ART) 5 Evidence-based psychosocial interventions and drug dependence treatments 6 Prevention, diagnosis and treatment of STIs, hepatitis and tuberculosis (TB) 7 Targeted information, education and communication (IEC) for people who use stimulant drugs and their sexual partners 8 Prevention and management of overdose and acute intoxication The core interventions should be adapted to the specific needs of different key populations. An assessment of the population to be served will assist in providing the evidence needed to design a clientcentred package of services that responds to specific needs. 2.1 Condoms, lubricants and safer sex programmes People who have sex while under the influence of stimulant drugs are more likely to engage in sexual risk behaviours, especially unprotected sex [83]. They may have reduced sexual inhibitions and a feeling of invincibility, which makes choosing or remembering to use a condom more challenging. Other factors that can contribute to inconsistent condom use include lack of access to condoms and lubricants when needed, poor safe-sex negotiations skills, being on PrEP [84] and engaging in risk-reduction strategies such as serosorting or strategic positioning. These strategies have their limits in terms of risk for HIV transmission, particularly if people are under the influence of stimulant drugs, and they do not prevent transmission of other STIs including HBV and HCV. Promoting the use of male and female condoms and appropriate lubricants remains a core HIV prevention strategy for people who use stimulant drugs and their sexual partners. Condoms offer protection against HIV, other STIs such as syphilis and gonorrhoea, and possible sexual transmission of HBV or HCV. Condoms can also prevent unintended pregnancy. Condoms and lubricants should be available widely, and without charge. Targeted distribution of free condoms helps overcome the barriers associated with their cost and can help reinforce the social acceptability of condom use. Distribution of condoms and sex-education information by peers and outreach workers plays an important role, including in the street or party setting. It is important to consider the variety of condoms available to meet key population preferences, and their distribution, to ensure wide availability of condoms and lubricant and access to them in places where people engage in stimulant drug use and sex concurrently. For example, in the case of sex-onpremises venues or nightclubs, simply making condoms available in the usual places, such as toilets or at the bar, is often not sufficient to ensure that people have them to hand when they need them. Consultation with the beneficiaries is critical to ensure easy access. Similarly, to ensure access to condoms in prisons, strategies must be tailored to each prison, based on its architecture, regime and the movements of prisoners within the prison. Safer-sex education for people who use stimulant drugs should cover: • Promotion of condoms and lubricant use • Information on sexual transmission of HIV, hepatitis and STIs • Safe-sex negotiation strategies • Information on strategies to reduce risks of HIV transmission (sero-sorting and strategic positioning), including their limitations • Information on pre-exposure prophylaxis of HIV (PrEP) Further resources The four key population implementation guides (the IDUIT, MSMIT, SWIT and TRANSIT) provide useful general information on condoms, lubricants and safer sex programming for people who inject drugs, men who have sex with men, sex workers and transgender people. 23 Chapter 2 Core interventions 2.2 Needle and syringe programmes and other commodities Due to the short duration of their effects, injection of stimulant drugs is frequently associated with rapidly repeated injecting, with some individuals reporting more than 20 injections a day. Injecting may take place in groups, and people may use several different stimulant drugs and other types of drug in the same session. These patterns of use increase the likelihood that non-sterile equipment will be used or shared, elevating the risk of HIV and hepatitis transmission. The accessibility and design of needle and syringe programmes (NSPs) must take into account the nature of stimulant drugs and patterns of their use. People who inject stimulant drugs should be educated, encouraged and supported to acquire sufficient sterile syringes. NSP policies and protocols should allow people who inject stimulant drugs access to enough injecting equipment for themselves and their peers. One-for-one exchange or other forms of restricted access to needles and syringes are not recommended in any situation and are particularly unhelpful with people who inject stimulant drugs [85][86]. In the party and club scene, injecting stimulant drugs is more likely to take place outside the normal operating hours of HIV harm reduction services. NSPs and other community drug services do not always engage with the party and club scene, compounding the lack of service availability or HIV prevention messaging. This lack of access is particularly problematic for people who inject stimulant drugs, who would benefit from access to an NSP and other services. Creative strategies can be used to make sterile needles and syringes available to people who inject stimulant drugs, particularly outside operating hours, and in the places where stimulant drugs are purchased or used. These may include satellite NSPs in projects or clinics for key populations, needle and syringe dispensing machines, secondary NSP, outreach programmes, safer clubbing initiatives, outreach at sex-on-premises venues (bars, saunas, clubs, etc.), outreach programmes at festivals, and community mobilization initiatives. NSPs designed to address the needs of people who use stimulant drugs, including all key populations, are well positioned to provide an entry point to a coordinated cascade of services, starting with voluntary HTS. They can also offer information on how to reduce risks related to the use of drugs, distribute female and male condoms and lubricant, and provide route transition interventions (see below). Efforts to understand the context of an individual’s drug use, their injecting equipment needs, and their concurrent sexual behaviours will help ensure that appropriate messaging is used. NSPs should also provide education, advice and equipment to support safer injecting practices, including on the importance of hand hygiene, avoiding sharing any paraphernalia (filters, water) associated with injecting, and keeping even the smallest amounts of blood out of the space where drugs are prepared for injection. It is also important to provide syringe disposal bins or plastic bins or containers for the safe disposal of used injecting equipment, which is key to preventing needle-stick injuries and reducing risk or inconvenience to the wider community associated with illicit drug injection. Syringes with colour-coded barrels provide an example of a promising practice that supports people who inject stimulant drugs in group settings. Each participant is assigned a different colour and provided with syringes of that colour which he or she alone is to use. This can help reduce the accidental sharing of injecting equipment, particularly if it is reused. Route transition interventions Route transition interventions support people who use drugs to avoid initiation into injecting, or to encourage people who are injecting to transition to non-injecting routes of administration. Behavioural interventions, peer education interventions and the provision of commodities that support alternatives to injecting, such as pipes, mouthguards and aluminium foil, can be used to engage with people who inject heroin and/or stimulant drugs. Box 3. A harm reduction programme for people who smoke cocaine or methamphetamines in the Pacific North-West United States The People’s Harm Reduction Alliance (PHRA) is a peer-based harm reduction programme for people who use drugs in the Pacific North-West of the United States, established in 2007. In its first year, PHRA provided syringes and sterile injection equipment; however, the need to expand services to include people who smoke drugs became quickly apparent via the peer-based framework and feedback from clients. In 2008, PHRA launched a crack pipe programme to reach a different group of people who use drugs. The programme has become a point of contact for them to access additional services. In 2015, the programme was expanded to include methamphetamine pipes because participants informed PHRA that lack of access to pipes led them to inject more frequently than they would otherwise do. Both pipe programmes have increased the inclusion of people who smoke crack and methamphetamine at PHRA and linked them to other essential health services. In 2016, PHRA expanded services for non-injectors further with a snorting programme. HIV and HCV prevention opportunities for people who smoke stimulant drugs Crack cocaine, cocaine base and methamphetamine can be smoked in a pipe, offering access to the high-dose surging effect. The repeated use of heated crack pipes can cause blisters, cracking and sores on the tongue, lips, face, nostrils and fingers. It has been suggested that this may facilitate HCV transmission via unsterile paraphernalia (although this has not been clearly established). People smoking stimulant drugs in pipes do not require single-use equipment but will benefit from having personal (individual) smoking equipment, and messaging that pipes should not be shared. The same principle applies for straws used to inhale cocaine. The distribution of pipes, mouthguards and other piping paraphernalia provides practical strategies for engaging stimulant drug smokers and reinforces the “Don’t share pipes” message. The principles of distributing paraphernalia and engaging people who smoke stimulant drugs with messages about HIV and hepatitis prevention remain the same. 25 Chapter 2 Core interventions Box 4. Example of content of kits for safer smoking • Pipes • Mouth- or lip guards – a rubber band, rubber tubing, or sometimes specially produced • Stainless steel wool, used as gauze to suspend the crack cocaine inside the pipe • Alcohol wipes to clean the pipe and reduce risks associated with sharing • Lip balm containing vitamin E, to help protect and heal chapped or injured lips • Sterile dressing to cover wounds or burns arising from smoking crack • Sugar-free chewing gum which can help stimulate saliva production to protect teeth and reduce dental damage • Condoms and lubricants to support safer sex practices • Health promotion leaflets Safe tattooing In some population groups who use stimulant drugs, unsafe tattooing is frequent and constitutes a risk for transmission of HCV. This is a particular issue in prisons where tattooing is prohibited and hidden and unhygienic tattooing is common. NSPs and other low-threshold services can offer safe tattooing information, training and safe equipment. 2.3 HIV testing services HIV testing provides an opportunity to deliver HIV prevention messages and to link people to HIVprevention and other relevant health and support services. HIV testing services (HTS) are also the critical entry point to ART (see section 2.4). Given the evidence that individuals who are ARTadherent and have achieved viral suppression do not transmit HIV, HTS is a crucial component of HIV prevention programmes. It is important to increase the opportunities for people who use stimulant drugs to access and use confidential, easy and convenient HIV testing that is linked to the provision of ART for those who test positive. Community-based rapid HIV testing provides an opportunity to deliver results immediately. This can be of particular importance with street- or venue-based people who use stimulant drugs, where the primary source of engagement may be outreach programmes brought to where they are, rather than waiting for them to present at a specific testing location. Other outreach opportunities may also be used to distribute HIV self-test kits. Regardless of the testing modality, it is important to have a protocol to assist people to get a confirmatory test if they test positive, and to access and successfully use HIV care and treatment services if needed, including immediate access to ART, post-exposure prophylaxis (PEP) or PrEP, as appropriate. On-site HIV testing can pose challenges, including the possible lack of confidentiality that comes especially with small, closed communities. Outreach workers and service providers need to ensure that HIV testing is always voluntary and that coercive use of self-test kits by third parties such as law enforcement or employers to test any individual (e.g., sex workers) is unacceptable. 2.4 Antiretroviral therapy Antiretroviral therapy (ART) is the treatment of people living with HIV with medications that suppress the replication of the virus. Currently the standard treatment consists of a combination of antiretroviral drugs (ARVs), and it is indicated for all people living with HIV, irrespective of their CD4 count. ART reduces morbidity and mortality rates among people living with HIV, improves their quality of life and reduces risks of transmission of HIV. ARVs are also administered to some groups of people at risk for HIV acquisition either before exposure (PrEP) or after (PEP). ART is also needed for prevention of mother-to-child transmission of HIV. Cocaine and ATS have been associated with faster disease progression in people living with HIV, due to weakening of the immune system by the drugs. However, if adherence is maintained, the effectiveness of ART is not reduced in people who use stimulant drugs: ART reduces viral load and improves immune function, just as it does for other people living with HIV [77]. Strategies to support adherence to ART, including peer and outreach support, are described in section 3.1. Side-effects of antiretroviral drugs and interactions with stimulant drugs As with many medications, ARVs have been associated with various side-effects, including acute or chronic alterations of the renal function, or hepatic dysfunction. Some medications can cause sideeffects in the central nervous system, such as depression. Liver toxicity is one of the most commonly reported adverse consequences associated with ARVs. This can range from asymptomatic elevation of the liver enzymes to a hepatic failure. Risks for ARVrelated adverse consequences for the liver are higher in cases of cocaine use, excessive alcohol use, coinfection with HBV or HCV, fibrosis of the liver, concomitant treatment for TB and advanced age. Impact of stimulant drugs on antiretroviral drug serum level Cocaine, mephedrone and methamphetamines interact with several ARVs, influencing the serum level of the medications and the risk of side-effects. As scientific knowledge progresses, new ARV regimens may be proposed, with the potential for interactions with the NPS that are frequently appearing on the market. The University of Liverpool provides a regularly updated website on HIV medication interactions, including the interaction of ARVs with stimulant drugs: https://www.hiv-druginteractions.org/treatment_selectors. Impact of antiretroviral drugs on serum level of stimulant drugs Serum levels of methamphetamines may increase up to three times when used by someone who is also taking protease inhibitors, especially ritonavir. Fatal cases attributed to inhibition of the metabolism of MDMA and amphetamines by ritonavir have been reported. Oral pre-exposure prophylaxis Oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral medications to prevent the acquisition of HIV infection by uninfected persons. WHO recommends daily oral PrEP as a prevention choice for people at substantial risk of HIV [91]; it can be stopped during periods of low or no risk. Taken as prescribed, PrEP can reduce the risk of getting HIV from sex with an HIV-positive person by more than 90 per cent [92]. PrEP has been effective in communities where the primary vector for transmission is sexual, such as men who have sex with men, and is therefore appropriate for people who use stimulant drugs. PrEP does not replace HIV prevention interventions, such as comprehensive condom programming for sex workers and men who have sex with men. It does not prevent transmission of hepatitis and other STIs. Services for people who inject stimulant drugs should prioritize evidence-based comprehensive HIV prevention interventions, including NSP, condoms and lubricants. For men who have sex with men who use stimulant drugs and engage in high-risk sex, PrEP should always be proposed, whether or not the individual injects drugs. Adherence to PrEP is essential, and it may be challenging for people using stimulant drugs for several days in a row. People who use stimulant drugs and engage in concurrent sex should be encouraged and supported to plan ahead to use condoms, lubricants and PrEP in combination, to ensure better protection against HIV and to prevent other STIs, including hepatitis C and B. As with other prevention tools, the effectiveness of PrEP is optimized when interventions are implemented by, and in close consultation with, prospective beneficiary communities. Further resources Implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection (WHO, 2017) [93] Post-exposure prophylaxis Post-exposure prophylaxis (PEP) is the administration of ARVs for a short term (one month) to prevent HIV infection after exposure to HIV through unprotected sex or contact with blood. PEP should be offered to all individuals who have potentially been exposed to HIV, whether through unprotected sex (including sexual assault), needle-stick injury or sharing drug injection equipment. It should be initiated as early as possible, ideally within 72 hours. People who use stimulant drugs and engage in sex concurrently are known to often have multiple sexual partners. The chances of unprotected sex or condom failure are increased with stimulant drug use or with the increase in the number of partners. A participative stakeholder process should lead to the development of protocols for community access to PEP, from local to national levels, to ensure that the required medications are promptly accessible and are used by those who need them. People who use stimulant drugs and who access PEP regularly should be assessed as likely candidates for PrEP. Further resources Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] 2.5 Evidence-based psychosocial interventions and drug dependence treatments The impact of a drug is determined by the complex interactions between the substance, set (the mindset of the individual) and setting (the context), which mediate the drug’s effect and its associated impact on the individual, including the move towards dependent or high-risk drug use [94]. The great majority of people who use stimulant drugs do so on an occasional basis that may be characterized as “recreational”, and they will not develop dependence. This group has little need for high-intensity interventions. This section provides an overview of possible interventions, mainly psychosocial ones, that show effectiveness specifically for reducing risk behaviours and provide support for people who regularly use stimulant drugs, including people living with HIV. 29 Chapter 2 Core interventions The treatment of cocaine or ATS drug dependence requires time-intensive approaches that are not addressed here. Unlike the treatment of opioid dependence, there are currently no substitution medications available to treat dependence on cocaine or ATS [95][96]. Some emerging practices around dispensing dexamphetamine as a substitute for cocaine or methamphetamine dependence have shown early promise, but further research is needed. Behavioural interventions, self-regulation coaching and psychosocial counselling can support HIV/HCV prevention and treatment objectives for people who use stimulant drugs, while also contributing to longer-term and broader health and wellness goals. There is evidence that brief interventions that concentrate on providing information about safe behaviours and harm mitigation are effective in moderating drug-related harms [97] and maintaining ART adherence for those who are living with HIV [98]. Addressing the potential risks associated with the nexus of drug use and HIV requires individual, structural and combination approaches [99]. Psychosocial services such as motivational interviewing, brief interventions, contingency management and cognitive behavioural therapy are critical to effectively support HIV prevention and treatment among people who use stimulant drugs. Some of these approaches are described below. A 2016 review of psychosocial interventions for stimulant drug-use disorders found that all showed improved retention in ART compared with no intervention, although no single intervention showed a sustained benefit over the others [100]. Psychosocial services should be based on principles of community inclusion and participation, peer support and the needs of the individual. When developing HIV prevention interventions, it is important that sexual partners of people who use stimulant drugs be included in the process, focusing on the HIV risks that are associated with drug use and concurrent sexual behaviours. Motivational interviewing Motivational interviewing is a person-centred, semi-directive approach for exploring motivation and ambivalence in order to facilitate self-motivational statements and behavioural changes. It consists in establishing a partnership between the provider and the individual and enabling the individual to become aware of the discrepancy between their present situation and their own values. The technique relies on four principles: express empathy, develop discrepancy, roll with resistance and support selfefficacy. These can easily be used by trained non-specialist staff, including outreach workers, in formal or informal counselling, IEC and other conversations. Motivational interviewing generally requires just one or two sessions. The success of motivational interviewing has led to its implementation as a “catch-all” approach to eliciting change in areas such as medication compliance, smoking cessation and diet and exercise [101]. A 2012 Cochrane review suggested that motivational interviewing could reduce risky sexual behaviour, and in the short term lead to a reduction of viral load in young people living with HIV [102]. Research has shown that motivational interviewing can reduce the incidence of unprotected anal intercourse among men who have sex with men [103], as well as levels of drug use [104]. Brief interventions Brief interventions are short, often opportunistic interactions in which a health worker provides targeted information and advice to individuals during other activities such as distributing sterile injecting equipment or conducting an HIV test. Brief interventions have been shown to reduce drug use as well as associated risks and sexual risk behaviours. Meta-analyses suggest that there is little difference in the outcomes between longer, more intensive interventions and brief interventions, and the latter are likely to be more practical and cost-effective options, with few barriers to implementation [105]. Motivational interviewing, contingency management and brief interventions for dependence to stimulant drugs can reduce drug-related high-risk sexual behaviours and increase adherence to ART and PrEP. 30 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Contingency management Contingency management is an approach that incentivizes people with rewards such as cash that are contingent on achieving a set of pre-defined outcomes. Contingency management has been shown to have a moderate yet consistent effect on drug use across different classes of drugs [106]. The effectiveness of contingency management supports the idea that small, regular rewards motivate people to modify behaviours that could be considered harmful. Positive regard, and the client’s own expressed belief in their ability to achieve goals, are a critical factor in improving agreed-upon outcomes. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) is a structured approach to counselling that assumes that behaviours are learned and reinforced as a result of cognitive constructs and deficits in coping. The aim of CBT is to “unlearn” behaviours considered unhelpful, such as HIV risk behaviour or certain patterns of drug-taking. While results appear to be sustained over a period, CBT is intensive and time-consuming, and demands specialist practitioners and individual treatment [107]. Mindfulness Mindfulness can be defined as the ability to focus open, non-judgemental attention on the full experience of internal and external phenomena, moment by moment. Positive outcomes – including reducing drug use and risk behaviours, and in relapse prevention – have been documented from mindfulness training as part of approaches to reduce harm, including for people who use stimulant drugs [108][109][110]. Opioid substitution therapy and stimulant drug use People receiving opioid substitution therapy (OST) for heroin or other opioid dependence may use stimulant drugs because of OST-triggered fatigue, inability to experience pleasure, or the desire to remain connected to the community of people who use drugs. OST is not designed to counter stimulant drug use, and the concurrent use of stimulant drugs while on OST should not be viewed as a breach, nor should it lead to the reduction or discontinuation of OST. The benefits of OST are independent of stimulant drug use [111]. Existing OST providers should be sensitized to this and trained to use the opportunities afforded by regular OST and client engagement to support the delivery of interventions included in this guidance. Further resources mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings (WHO, 2010) [112] Therapeutic interventions for users of amphetamine-type stimulants (WHO, 2011) [113] Harm reduction and brief interventions for ATS users (WHO, 2011) [114] Guidelines for the management of methamphetamine use disorders in Myanmar (Ministry of Health and Sports, Myanmar, 2017) [115] Guidance for working with cocaine and crack users in primary care (Royal College of General Practitioners, 2004) [116] Principles of drug dependence treatment (UNODC, WHO, 2008) [117] Drug abuse treatment and rehabilitation: a practical planning and implementation guide (UNODC, 2003) [118] TREATNET quality standards for drug dependence treatment and care services (UNODC, 2012) [111] Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (WHO, 2009)[163] Treatment of stimulant use disorders: current practices and promising perspectives. Discussion paper (UNODC, 2019)[164] 31 Chapter 2 Core interventions 2.6 Prevention, diagnosis and treatment of sexually transmitted infections, hepatitis and tuberculosis Screening people who use stimulant drugs for infectious diseases, such as sexually transmitted infections (STIs), HBV, HCV and TB, is a crucial part of a comprehensive approach. Along with HIV, these infections are often associated with the use of illicit substances, and they may co-occur with stimulant drug use. Prevention, diagnosis and treatment of sexually transmitted infections Unsafe sex can lead to acute STIs, which can cause infertility and severe illness. Several STIs, particularly those involving genital or perianal ulcers, may facilitate the sexual transmission of HIV infection. Sex workers, transgender people and men who have sex with men are often at increased risk of STIs such as syphilis, gonorrhoea, chlamydia and herpes. It is therefore important to offer information, male and female condoms and lubricant, and screening, diagnosis and treatment of STIs and possibly HPV vaccine to people using stimulant drugs who are vulnerable to STIs and HIV. Further resources Resources on sexually transmitted and reproductive tract infections (WHO webpage providing clinical, policy and programmatic, monitoring and evaluation and advocacy guides) [119] Prevention, vaccination, diagnosis and treatment of hepatitis B and C People who inject stimulant drugs are at heightened risk of acquiring HBV and HCV because of frequent injecting and sharing of injection equipment. The risk of sharing equipment is higher when injecting happens in communal settings. HCV is much more virulent than HIV and can survive outside the body at room temperature, on environmental surfaces, for up to three weeks [120], making it more easily transmitted through the sharing of syringes and other injecting paraphernalia. Key populations who use stimulant drugs should be offered hepatitis B or hepatitis A-B vaccination, access to prevention commodities, and voluntary screening and treatment of HBV and HCV. Prevention NSPs and community mobilization initiatives should distribute relevant equipment, including low dead-space syringes, for injecting, smoking and snorting (see section 2.2). Male and female condom programming is also part of hepatitis B and C prevention interventions as well as sexual and reproductive health services. Education should include messages on the risks of serosorting, and of intense sexual practices involving potential trauma of the mucosa for HCV acquisition and transmission among people living with HIV [50]. Hepatitis A and B vaccination Key populations should be offered the series of HBV immunizations. WHO recommends: • Offering people the rapid hepatitis B vaccination regimen (days 0, 7 and 21-30). • Providing people who inject drugs with incentives in order to increase hepatitis B vaccination adherence, at least for the second dose. Even partial immunization confers some immunoprotection. [87] Hepatitis A (HAV) immunization or combined HAV-HBV immunization should be offered to men who have sex with men and people using stimulant drugs [121]. 32 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Immunization should be easily accessible and offered at locations and venues frequented by people who use stimulant drugs, such as drop-in centres, NSPs and other community service outlets. Screening for HBV and HCV Voluntary screening for HBV and/or HCV should be offered to people who use stimulant drugs at risk of these infections. Testing and diagnosis of HBV and HCV infection is an entry point for accessing both prevention and treatment services. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay the progression of liver disease. Rapid tests for hepatitis C allow for better access to diagnosis, including communitybased testing. Treatment of chronic hepatitis C or B All people with chronic hepatitis C should receive treatment. With an 8- to 12-week course, directacting antivirals (DAAs) cure more than 95 per cent of persons with HCV infection, reducing the risk of death from liver cancer and cirrhosis. For chronic hepatitis B, antiviral treatment can slow down the progression of cirrhosis and reduces the risk of liver cancer [162]. People who are actively injecting drugs have been shown to adhere to HCV treatment regimens as well as any other population, particularly when social, emotional and practical support are provided [122]. All people who use stimulant drugs living with HCV should therefore be offered access to direct-acting antivirals without discrimination. Further resources Guidance on prevention of viral hepatitis B and C among people who inject drugs (WHO, 2012) [87] Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection (WHO, 2016) [123] Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] Prevention, diagnosis and treatment of tuberculosis In 2016, 10.4 million people fell ill with TB. It is a leading killer of people living with HIV: in 2016, 40 per cent of HIV deaths were due to TB [124]. Transmission of TB is easily facilitated through airborne particulates, such as by kissing, coughing, sneezing or shouting. TB is easily spread in prisons and other closed settings, and in crowded and poorly ventilated spaces, such as are often found in poor communities or among homeless people. People who inject drugs are at increased risk of TB, irrespective of their HIV status, and TB is a leading cause of mortality among people who inject drugs who also have HIV infection [125]. People who use drugs who do not inject have also been found to have increased rates of TB. Certain subgroups of stimulant drug users, such as those who use stimulant drugs regularly for days at a time, may be immuno-deficient from lack of sleep and food, facilitating TB transmission. It is therefore important to include TB prevention, screening and treatment in communities and services. Further resources Integrating collaborative TB and HIV services within a comprehensive package of care for people who inject drugs: consolidated guidelines (WHO, 2016) [125] 33 Chapter 2 Core interventions 2.7 Targeted information, education and communication To reduce the risk of acquiring STIs or HIV, people who use stimulant drugs need knowledge and support. Information, education and communication (IEC) provides information, motivation, education and skills-building to help individuals adopt behaviours that will protect their health. Effective communication for health targeting people who use stimulant drugs requires addressing two challenges: • Crafting messages that can overcome long-standing distrust and fear. • Finding effective means of reaching people who use stimulant drugs with life-saving messages and materials. Key to meeting these challenges is meaningful engagement with the target audience of people who use stimulant drugs. Communities should be represented at every stage of IEC development, including the overall strategy and concept, and the development, testing, dissemination and evaluation of messages. Working with the community will help ensure that tools and materials are accurate and will be trusted and used. Recipients of IEC who have invested their own ideas and time in it will be more likely to stand behind the results and be active participants, not only in their own health but in health promotion in their community. Materials must be easily understandable and to the point. Interactive materials on a digital platform can tailor messaging to the specific situation of the service user and are often helpful in maintaining attention. On the other hand, traditional printed materials have the advantage of not requiring computer, phone or Internet access. They also provide an opportunity for outreach workers or other programme staff distributing the materials to interact with the service users, and a means for service users to easily share information with others. Using information technology to support behavioural interventions Online and social media can be a cost-effective manner of reaching targeted audiences. A local assessment can show where using these technologies will be advantageous and appropriate. Free WiFi at drop-in centres and other community points of congregation provides opportunities for access and use. Where people who use stimulant drugs have smartphones, websites and apps can be deployed just as they have been to reach other key populations. The use of technology has shown promising results in promoting sexual health or adherence to ART in different settings, including resource-limited settings [126][127]. Web-based applications provide an opportunity to reach a large audience at any time and provide information on health and available services. They also allow for online outreach and interactions with people who wish to discuss problems or have questions. However, when the information relates to drug use, or other criminalized behaviours, the use of some digital media raises concerns about the anonymity of the contacts, and possible risks related to law enforcement must be addressed. Working with communities and low-threshold service providers will help inform the local potential for digital materials and campaigns and help ensure the security of people accessing information. Given the variety that exists among people who use stimulant drugs, messaging should take into account the sex, gender, sexual orientation, age and setting of recipients of IEC. Literacy levels, social and community inclusion or exclusion, and other cultural and societal variables must also be considered. 34 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Further resources The European Centre for Disease Prevention and Control (ECDC) has developed guidance documents for the effective use of social media. While the tools were developed for Europe, and specifically for reaching men who have sex with men, they provide guidance on the relative advantages of different media, such as Facebook, online outreach, Google Ads, SMS and YouTube, that may be useful in other contexts. Effective use of digital platforms for HIV prevention among men who have sex with men in the European Union/European Economic Area: an introduction to the ECDC guides (ECDC, 2017) [128] 2.8 Overdose and acute intoxication prevention and management Very high doses of stimulant drugs consumed in a short amount of time can trigger acute respiratory distress, chest pain, palpitations or myocardial infarctions [112]. In extreme cases this can result in cardiac arrest. The first signs of stimulant drugs intoxication are hyperactivity, rapid speech and dilated pupils. In the case of polydrug use, overdose can be the result of the combination of stimulants with other drugs including opioid or sedative drugs. The treatment of stimulant drugs intoxication is symptomatic and requires regular monitoring of blood pressure, pulse rate, respiratory rate and temperature (figure I.). Serotonergic syndrome is caused by an excess of serotonin in the central nervous system associated with the use of ATS. It can result in uncontrollable muscle spasms, tremor, seizures, psychosis, high blood pressure, high body temperature >400 C (hyperthermia) and release of myoglobin from muscles and blood clotting in vessels (disseminated intravascular coagulation), which may lead to severe diseases and potentially death. People who use stimulant drugs need to be informed on how to reduce the risks of acute intoxications (see the Information checklist for self-care and stimulant drugs in the annex). For people on PrEP, ART or hepatitis treatment, information should be provided on the interactions and possible risks of cocaine and ATS use to serum levels (see section 2.4). People who use stimulant drugs should be trained to recognize overdoses, provide first aid, including cardiopulmonary resuscitation (CPR) and call immediately for emergency professional assistance if they witness an overdose.
USER:
What are the key considerations and strategies for people who use stimulant drugs and engage in concurrent sex in terms of HIV prevention, and how does the effectiveness of these strategies get optimized?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
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My daughter was recently diagnosed with hyperhidrosis. What are the signs and symptoms of this? I'm also looking to know what causes this, including any underlying medical conditions. Are there any medications that can help with the excessive sweating? Her doctor wants to run some tests and I was wondering what some of those might be. Is this a common ailment?
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Hyperhidrosis is excessive sweating. This condition happens when you sweat more than what your body needs to regulate your temperature. You may experience sweating when you’re at rest, in cold temperatures or randomly at times when you wouldn’t expect to sweat. There are two types of hyperhidrosis: Primary focal hyperhidrosis: Focal hyperhidrosis is a chronic skin condition. A genetic change (mutation) causes this condition. You can inherit it from your biological family. This is the most common type of hyperhidrosis. It usually affects your armpits, hands, feet and face. It tends to start before age 25. Secondary generalized hyperhidrosis: Generalized hyperhidrosis is excessive sweating caused by an underlying medical condition or it’s a side effect of a medication. Some examples include diabetes and Parkinson’s disease and medications, such as naproxen (Aleve®). Generalized hyperhidrosis may cause you to sweat while sleeping. How common is hyperhidrosis? Hyperhidrosis is common. Research suggests that an estimated 3% of adults in the United States between ages 20 and 60 have hyperhidrosis. What are the symptoms of hyperhidrosis? The main symptom of hyperhidrosis is sweating. When you sweat, you may feel: Wetness on your skin. Damp clothing. Beads of fluid dripping from your cheeks or forehead. Over time, hyperhidrosis can lead to the following symptoms: Itching and inflammation when sweat irritates your skin. Body odor, which occurs when bacteria on your skin mixes with sweat particles. Cracked or peeling skin on your feet. Hyperhidrosis symptoms can range in severity. You may have minor symptoms that come and go or you may have constant symptoms that have an impact on your day-to-day activities. Sweat comes from eccrine glands, which exist in the skin throughout your body. You have the most eccrine glands in your: Armpits or underarms (axillary hyperhidrosis). Soles of your feet (plantar hyperhidrosis). Palms of your hands (palmar hyperhidrosis). Forehead and cheeks (craniofacial hyperhidrosis). Genitals. Lower back. The most common location on your body to experience excessive sweating is the palms of your hands. What causes hyperhidrosis? Overactive sweat glands cause hyperhidrosis. Your eccrine glands (sweat glands) create sweat to cool down your body when you get hot. This process activates when you exercise or if you’re nervous. If you have hyperhidrosis, your eccrine glands activate and produce sweat more often than when your body is too hot. You may experience sweating at random times of the day when there isn’t something like an activity or emotion causing your glands to produce sweat. Research is ongoing to learn more about why your glands make too much sweat. Your body produces sweat to cool it down and prevent overheating. There may be certain triggers in your environment that can cause your sweat glands to produce more sweat including: Certain emotions like stress, anxiety, fear or nervousness. Warm temperatures or humidity. Exercise or physical activity. Certain foods and beverages, like spicy foods, fatty foods, sugary and salty foods, and foods with high levels of protein. Beverage examples include caffeinated beverages (coffee) and alcohol. Medications that cause sweating Certain medications can cause sweating as a side effect, including but not limited to: Albuterol (Proventil®). Bupropion (Wellbutrin®). Hydrocodone. Insulin (Humulin® R, Novolin® R). Levothyroxine. Lisinopril. Naproxen (Aleve®). Omeprazole (Prilosec®). Sertraline (Zoloft®). Hyperhidrosis (generalized) could be a sign of an underlying medical condition including but not limited to: Acromegaly. An infection (tuberculosis). Anxiety. Cancer. Diabetes. Heart disease or heart failure. Hyperthyroidism. Menopause. Obesity. Parkinson’s disease. Does hyperhidrosis run in families? Yes, you may be more at risk of hyperhidrosis, specifically focal hyperhidrosis, if someone in your biological family has the condition. Research indicates that a hereditary genetic mutation or change to your DNA could cause hyperhidrosis. Hyperhidrosis can cause complications that include: A skin infection. Skin changes, such as paleness, discoloration, cracks or wrinkles. Maceration, or unusually soft, moist skin. Hyperhidrosis can also impact your mental health. You may find yourself changing your routine to hide your symptoms from others. Constant sweating may be so severe that you avoid common actions, such as lifting your arms or shaking hands. You may even give up activities you enjoy to avoid problems or embarrassment from excessive sweating. Contact a healthcare provider if hyperhidrosis affects your mental health and social well-being. Diagnosis and Tests How is hyperhidrosis diagnosed? A healthcare provider will diagnose hyperhidrosis after a physical exam and learning more about your symptoms and medical history. They’ll evaluate your symptoms using diagnostic criteria. If you experienced excessive sweating for at least six months and answered yes to at least two of the following questions, it may lead to a hyperhidrosis diagnosis: Sweating occurs on your underarms, palms, soles or face. You sweat the same on both sides of your body. You don’t sweat at night or sweat less at night. An episode of sweating lasts for at least one week. You have a history of hyperhidrosis in your biological family. Sweating interferes with your ability to do certain activities. You’re younger than 25 years old. What tests diagnose hyperhidrosis? A healthcare provider may use one of the following tests to determine the cause of hyperhidrosis: Starch-iodine test: Your provider applies an iodine solution to the sweaty area and sprinkles starch over the iodine solution. In places where you have excess sweating, the solution turns dark blue. Paper test: Your provider places special paper on the affected area to absorb sweat. Later, your provider weighs the paper to determine how much sweat you have. Blood or imaging tests: These tests can take a sample of your blood or take pictures underneath your skin to help your healthcare provider learn more about what causes your symptoms. Management and Treatment You can manage your symptoms of hyperhidrosis at home by: Using antiperspirants and deodorants. Antiperspirants work by sealing up sweat glands so your body stops producing sweat. A provider may recommend certain over-the-counter (OTC) or prescription-strength varieties. The best deodorant for hyperhidrosis is an aluminum-based product. Showering or bathing more often. Changing your routine, such as showering more often, may improve mild symptoms. Wearing breathable clothing. Choosing clothing that’s breathable and more absorbent, like cotton, can help you feel more comfortable if you sweat. Avoid blended fabrics and polyester, which can trap heat and make you sweat more. Hyperhidrosis medications A healthcare provider or dermatologist may recommend taking medications to reduce your symptoms of hyperhidrosis, including: Anticholinergic agents (glycopyrrolate and oxybutynin). Antidepressants. Beta-blockers. Medicated wipes (glycopyrronium tosylate, Qbrexza®). Aluminum chloride gel. Hyperhidrosis treatment therapies If your symptoms don’t improve with at-home treatment and/or medications, your healthcare provider may recommend more specialized therapies: Iontophoresis: You place your hands or feet in a shallow tub of tap water. A special device emits a low electrical current through the water, blocking sweat glands over time. Each treatment takes 10 to 20 minutes. You may need repeated treatments. Insurance may cover the equipment, enabling you to do the therapy at home. Botulinum toxin (Botox®) injections: Injecting botulinum toxin into an overactive nerve can stop sweat production for months at a time. Repeat treatments are necessary. Microwave therapy: Your provider places a high-tech device (miraDry®) against the affected area of your skin. The device emits thermal energy (heat), which destroys sweat glands permanently. This is an hour-long procedure that takes place in a healthcare provider’s office. Hyperhidrosis surgery Endoscopic thoracic sympathectomy: ETS is a minimally invasive type of surgery where a surgeon will cut a nerve in your body to turn off the signal that tells your glands to produce sweat. Sweat gland removal: A surgeon will remove your sweat glands using a laser, scraping (curettage), cutting (excision) or liposuction. Surgery has the potential to offer lasting benefits for persistent sweating that doesn’t respond to other therapies.
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> My daughter was recently diagnosed with hyperhidrosis. What are the signs and symptoms of this? I'm also looking to know what causes this, including any underlying medical conditions. Are there any medications that can help with the excessive sweating? Her doctor wants to run some tests and I was wondering what some of those might be. Is this a common ailment? <TEXT> Hyperhidrosis is excessive sweating. This condition happens when you sweat more than what your body needs to regulate your temperature. You may experience sweating when you’re at rest, in cold temperatures or randomly at times when you wouldn’t expect to sweat. There are two types of hyperhidrosis: Primary focal hyperhidrosis: Focal hyperhidrosis is a chronic skin condition. A genetic change (mutation) causes this condition. You can inherit it from your biological family. This is the most common type of hyperhidrosis. It usually affects your armpits, hands, feet and face. It tends to start before age 25. Secondary generalized hyperhidrosis: Generalized hyperhidrosis is excessive sweating caused by an underlying medical condition or it’s a side effect of a medication. Some examples include diabetes and Parkinson’s disease and medications, such as naproxen (Aleve®). Generalized hyperhidrosis may cause you to sweat while sleeping. How common is hyperhidrosis? Hyperhidrosis is common. Research suggests that an estimated 3% of adults in the United States between ages 20 and 60 have hyperhidrosis. What are the symptoms of hyperhidrosis? The main symptom of hyperhidrosis is sweating. When you sweat, you may feel: Wetness on your skin. Damp clothing. Beads of fluid dripping from your cheeks or forehead. Over time, hyperhidrosis can lead to the following symptoms: Itching and inflammation when sweat irritates your skin. Body odor, which occurs when bacteria on your skin mixes with sweat particles. Cracked or peeling skin on your feet. Hyperhidrosis symptoms can range in severity. You may have minor symptoms that come and go or you may have constant symptoms that have an impact on your day-to-day activities. Sweat comes from eccrine glands, which exist in the skin throughout your body. You have the most eccrine glands in your: Armpits or underarms (axillary hyperhidrosis). Soles of your feet (plantar hyperhidrosis). Palms of your hands (palmar hyperhidrosis). Forehead and cheeks (craniofacial hyperhidrosis). Genitals. Lower back. The most common location on your body to experience excessive sweating is the palms of your hands. What causes hyperhidrosis? Overactive sweat glands cause hyperhidrosis. Your eccrine glands (sweat glands) create sweat to cool down your body when you get hot. This process activates when you exercise or if you’re nervous. If you have hyperhidrosis, your eccrine glands activate and produce sweat more often than when your body is too hot. You may experience sweating at random times of the day when there isn’t something like an activity or emotion causing your glands to produce sweat. Research is ongoing to learn more about why your glands make too much sweat. Your body produces sweat to cool it down and prevent overheating. There may be certain triggers in your environment that can cause your sweat glands to produce more sweat including: Certain emotions like stress, anxiety, fear or nervousness. Warm temperatures or humidity. Exercise or physical activity. Certain foods and beverages, like spicy foods, fatty foods, sugary and salty foods, and foods with high levels of protein. Beverage examples include caffeinated beverages (coffee) and alcohol. Medications that cause sweating Certain medications can cause sweating as a side effect, including but not limited to: Albuterol (Proventil®). Bupropion (Wellbutrin®). Hydrocodone. Insulin (Humulin® R, Novolin® R). Levothyroxine. Lisinopril. Naproxen (Aleve®). Omeprazole (Prilosec®). Sertraline (Zoloft®). Hyperhidrosis (generalized) could be a sign of an underlying medical condition including but not limited to: Acromegaly. An infection (tuberculosis). Anxiety. Cancer. Diabetes. Heart disease or heart failure. Hyperthyroidism. Menopause. Obesity. Parkinson’s disease. Does hyperhidrosis run in families? Yes, you may be more at risk of hyperhidrosis, specifically focal hyperhidrosis, if someone in your biological family has the condition. Research indicates that a hereditary genetic mutation or change to your DNA could cause hyperhidrosis. Hyperhidrosis can cause complications that include: A skin infection. Skin changes, such as paleness, discoloration, cracks or wrinkles. Maceration, or unusually soft, moist skin. Hyperhidrosis can also impact your mental health. You may find yourself changing your routine to hide your symptoms from others. Constant sweating may be so severe that you avoid common actions, such as lifting your arms or shaking hands. You may even give up activities you enjoy to avoid problems or embarrassment from excessive sweating. Contact a healthcare provider if hyperhidrosis affects your mental health and social well-being. Diagnosis and Tests How is hyperhidrosis diagnosed? A healthcare provider will diagnose hyperhidrosis after a physical exam and learning more about your symptoms and medical history. They’ll evaluate your symptoms using diagnostic criteria. If you experienced excessive sweating for at least six months and answered yes to at least two of the following questions, it may lead to a hyperhidrosis diagnosis: Sweating occurs on your underarms, palms, soles or face. You sweat the same on both sides of your body. You don’t sweat at night or sweat less at night. An episode of sweating lasts for at least one week. You have a history of hyperhidrosis in your biological family. Sweating interferes with your ability to do certain activities. You’re younger than 25 years old. What tests diagnose hyperhidrosis? A healthcare provider may use one of the following tests to determine the cause of hyperhidrosis: Starch-iodine test: Your provider applies an iodine solution to the sweaty area and sprinkles starch over the iodine solution. In places where you have excess sweating, the solution turns dark blue. Paper test: Your provider places special paper on the affected area to absorb sweat. Later, your provider weighs the paper to determine how much sweat you have. Blood or imaging tests: These tests can take a sample of your blood or take pictures underneath your skin to help your healthcare provider learn more about what causes your symptoms. Management and Treatment You can manage your symptoms of hyperhidrosis at home by: Using antiperspirants and deodorants. Antiperspirants work by sealing up sweat glands so your body stops producing sweat. A provider may recommend certain over-the-counter (OTC) or prescription-strength varieties. The best deodorant for hyperhidrosis is an aluminum-based product. Showering or bathing more often. Changing your routine, such as showering more often, may improve mild symptoms. Wearing breathable clothing. Choosing clothing that’s breathable and more absorbent, like cotton, can help you feel more comfortable if you sweat. Avoid blended fabrics and polyester, which can trap heat and make you sweat more. Hyperhidrosis medications A healthcare provider or dermatologist may recommend taking medications to reduce your symptoms of hyperhidrosis, including: Anticholinergic agents (glycopyrrolate and oxybutynin). Antidepressants. Beta-blockers. Medicated wipes (glycopyrronium tosylate, Qbrexza®). Aluminum chloride gel. Hyperhidrosis treatment therapies If your symptoms don’t improve with at-home treatment and/or medications, your healthcare provider may recommend more specialized therapies: Iontophoresis: You place your hands or feet in a shallow tub of tap water. A special device emits a low electrical current through the water, blocking sweat glands over time. Each treatment takes 10 to 20 minutes. You may need repeated treatments. Insurance may cover the equipment, enabling you to do the therapy at home. Botulinum toxin (Botox®) injections: Injecting botulinum toxin into an overactive nerve can stop sweat production for months at a time. Repeat treatments are necessary. Microwave therapy: Your provider places a high-tech device (miraDry®) against the affected area of your skin. The device emits thermal energy (heat), which destroys sweat glands permanently. This is an hour-long procedure that takes place in a healthcare provider’s office. Hyperhidrosis surgery Endoscopic thoracic sympathectomy: ETS is a minimally invasive type of surgery where a surgeon will cut a nerve in your body to turn off the signal that tells your glands to produce sweat. Sweat gland removal: A surgeon will remove your sweat glands using a laser, scraping (curettage), cutting (excision) or liposuction. Surgery has the potential to offer lasting benefits for persistent sweating that doesn’t respond to other therapies. https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis
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<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
EVIDENCE:
Hyperhidrosis is excessive sweating. This condition happens when you sweat more than what your body needs to regulate your temperature. You may experience sweating when you’re at rest, in cold temperatures or randomly at times when you wouldn’t expect to sweat. There are two types of hyperhidrosis: Primary focal hyperhidrosis: Focal hyperhidrosis is a chronic skin condition. A genetic change (mutation) causes this condition. You can inherit it from your biological family. This is the most common type of hyperhidrosis. It usually affects your armpits, hands, feet and face. It tends to start before age 25. Secondary generalized hyperhidrosis: Generalized hyperhidrosis is excessive sweating caused by an underlying medical condition or it’s a side effect of a medication. Some examples include diabetes and Parkinson’s disease and medications, such as naproxen (Aleve®). Generalized hyperhidrosis may cause you to sweat while sleeping. How common is hyperhidrosis? Hyperhidrosis is common. Research suggests that an estimated 3% of adults in the United States between ages 20 and 60 have hyperhidrosis. What are the symptoms of hyperhidrosis? The main symptom of hyperhidrosis is sweating. When you sweat, you may feel: Wetness on your skin. Damp clothing. Beads of fluid dripping from your cheeks or forehead. Over time, hyperhidrosis can lead to the following symptoms: Itching and inflammation when sweat irritates your skin. Body odor, which occurs when bacteria on your skin mixes with sweat particles. Cracked or peeling skin on your feet. Hyperhidrosis symptoms can range in severity. You may have minor symptoms that come and go or you may have constant symptoms that have an impact on your day-to-day activities. Sweat comes from eccrine glands, which exist in the skin throughout your body. You have the most eccrine glands in your: Armpits or underarms (axillary hyperhidrosis). Soles of your feet (plantar hyperhidrosis). Palms of your hands (palmar hyperhidrosis). Forehead and cheeks (craniofacial hyperhidrosis). Genitals. Lower back. The most common location on your body to experience excessive sweating is the palms of your hands. What causes hyperhidrosis? Overactive sweat glands cause hyperhidrosis. Your eccrine glands (sweat glands) create sweat to cool down your body when you get hot. This process activates when you exercise or if you’re nervous. If you have hyperhidrosis, your eccrine glands activate and produce sweat more often than when your body is too hot. You may experience sweating at random times of the day when there isn’t something like an activity or emotion causing your glands to produce sweat. Research is ongoing to learn more about why your glands make too much sweat. Your body produces sweat to cool it down and prevent overheating. There may be certain triggers in your environment that can cause your sweat glands to produce more sweat including: Certain emotions like stress, anxiety, fear or nervousness. Warm temperatures or humidity. Exercise or physical activity. Certain foods and beverages, like spicy foods, fatty foods, sugary and salty foods, and foods with high levels of protein. Beverage examples include caffeinated beverages (coffee) and alcohol. Medications that cause sweating Certain medications can cause sweating as a side effect, including but not limited to: Albuterol (Proventil®). Bupropion (Wellbutrin®). Hydrocodone. Insulin (Humulin® R, Novolin® R). Levothyroxine. Lisinopril. Naproxen (Aleve®). Omeprazole (Prilosec®). Sertraline (Zoloft®). Hyperhidrosis (generalized) could be a sign of an underlying medical condition including but not limited to: Acromegaly. An infection (tuberculosis). Anxiety. Cancer. Diabetes. Heart disease or heart failure. Hyperthyroidism. Menopause. Obesity. Parkinson’s disease. Does hyperhidrosis run in families? Yes, you may be more at risk of hyperhidrosis, specifically focal hyperhidrosis, if someone in your biological family has the condition. Research indicates that a hereditary genetic mutation or change to your DNA could cause hyperhidrosis. Hyperhidrosis can cause complications that include: A skin infection. Skin changes, such as paleness, discoloration, cracks or wrinkles. Maceration, or unusually soft, moist skin. Hyperhidrosis can also impact your mental health. You may find yourself changing your routine to hide your symptoms from others. Constant sweating may be so severe that you avoid common actions, such as lifting your arms or shaking hands. You may even give up activities you enjoy to avoid problems or embarrassment from excessive sweating. Contact a healthcare provider if hyperhidrosis affects your mental health and social well-being. Diagnosis and Tests How is hyperhidrosis diagnosed? A healthcare provider will diagnose hyperhidrosis after a physical exam and learning more about your symptoms and medical history. They’ll evaluate your symptoms using diagnostic criteria. If you experienced excessive sweating for at least six months and answered yes to at least two of the following questions, it may lead to a hyperhidrosis diagnosis: Sweating occurs on your underarms, palms, soles or face. You sweat the same on both sides of your body. You don’t sweat at night or sweat less at night. An episode of sweating lasts for at least one week. You have a history of hyperhidrosis in your biological family. Sweating interferes with your ability to do certain activities. You’re younger than 25 years old. What tests diagnose hyperhidrosis? A healthcare provider may use one of the following tests to determine the cause of hyperhidrosis: Starch-iodine test: Your provider applies an iodine solution to the sweaty area and sprinkles starch over the iodine solution. In places where you have excess sweating, the solution turns dark blue. Paper test: Your provider places special paper on the affected area to absorb sweat. Later, your provider weighs the paper to determine how much sweat you have. Blood or imaging tests: These tests can take a sample of your blood or take pictures underneath your skin to help your healthcare provider learn more about what causes your symptoms. Management and Treatment You can manage your symptoms of hyperhidrosis at home by: Using antiperspirants and deodorants. Antiperspirants work by sealing up sweat glands so your body stops producing sweat. A provider may recommend certain over-the-counter (OTC) or prescription-strength varieties. The best deodorant for hyperhidrosis is an aluminum-based product. Showering or bathing more often. Changing your routine, such as showering more often, may improve mild symptoms. Wearing breathable clothing. Choosing clothing that’s breathable and more absorbent, like cotton, can help you feel more comfortable if you sweat. Avoid blended fabrics and polyester, which can trap heat and make you sweat more. Hyperhidrosis medications A healthcare provider or dermatologist may recommend taking medications to reduce your symptoms of hyperhidrosis, including: Anticholinergic agents (glycopyrrolate and oxybutynin). Antidepressants. Beta-blockers. Medicated wipes (glycopyrronium tosylate, Qbrexza®). Aluminum chloride gel. Hyperhidrosis treatment therapies If your symptoms don’t improve with at-home treatment and/or medications, your healthcare provider may recommend more specialized therapies: Iontophoresis: You place your hands or feet in a shallow tub of tap water. A special device emits a low electrical current through the water, blocking sweat glands over time. Each treatment takes 10 to 20 minutes. You may need repeated treatments. Insurance may cover the equipment, enabling you to do the therapy at home. Botulinum toxin (Botox®) injections: Injecting botulinum toxin into an overactive nerve can stop sweat production for months at a time. Repeat treatments are necessary. Microwave therapy: Your provider places a high-tech device (miraDry®) against the affected area of your skin. The device emits thermal energy (heat), which destroys sweat glands permanently. This is an hour-long procedure that takes place in a healthcare provider’s office. Hyperhidrosis surgery Endoscopic thoracic sympathectomy: ETS is a minimally invasive type of surgery where a surgeon will cut a nerve in your body to turn off the signal that tells your glands to produce sweat. Sweat gland removal: A surgeon will remove your sweat glands using a laser, scraping (curettage), cutting (excision) or liposuction. Surgery has the potential to offer lasting benefits for persistent sweating that doesn’t respond to other therapies.
USER:
My daughter was recently diagnosed with hyperhidrosis. What are the signs and symptoms of this? I'm also looking to know what causes this, including any underlying medical conditions. Are there any medications that can help with the excessive sweating? Her doctor wants to run some tests and I was wondering what some of those might be. Is this a common ailment?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
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Respond to the prompt using only information provided in the context block. Do not use any external knowledge or information not present in the given text. Your response should focus on providing factual details from the text. Use formal language and avoid any personal opinions or interpretations. If the prompt asks about something not covered in the context, state that the information is not available in the given text.
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What specific example does the author use to illustrate the effects of division of labor in a "very trifling manufacture"?
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THE greatest improvement in the productive powers of labour, and the greater part of the skill, dexterity, and judgment with which it is any where directed, or applied, seem to have been the effects of the division of labour. The effects of the division of labour, in the general business of society, will be more easily understood, by considering in what manner it operates in some particular manufactures. It is commonly supposed to be carried i furthest in some very trifling ones; not perhaps that it really is carried further in them than in others of more importance: but in those trifling manufactures which are destined to supply the small wants of but a small number of people, the whole number of workmen must necessarily be small; and those employed in every different branch of the work can often be collected into the same [7] workhouse, and placed at once under the view of the spectator. In those great manufactures, on the contrary, which are _- destined to supply the great wants of the great body of the people, every different branch of the work employs so great a number of workmen, that it is impossible to collect them all into the same workhouse. We can seldom b see more, at one time, than those employed in one single branch. Though [ bin such manufactures, b therefore, the work may really be divided into a r much greater number of parts, than in those of a more trifling nature, the division is not near so obvious, and has accordingly been much less observed. 3 To take an example, therefore, from a very trifling manufacture; but one in which the division of labour has been very often taken notice of, the trade of the pin-maker; a workman not educated to this business (which the division of labour has rendered a distinct trade), nor acquainted with the use of the machinery employed in it (to the invention of which the same division of labour has probably given occasion), could scarce, perhaps, with his utmost industry, make one pin in a day, and certainly could not make twenty. 2 But in the way in which this business is now carried on, not only the whole work is a peculiar trade, but it is divided into a number of branches, of which the greater part are likewise peculiar trades. One man draws out the wire, another straights it, a third cuts it, a fourth points it, a fifth grinds it at the top for receiving the head; to make the head requires [8] two or three distinct operations; to put it on, is a peculiar business, to whiten the pins is another; it is even a trade by itself to put them into the paper; and the important business of making a pin is, in this manner, divided into about eighteen distinct operations, 3 which, in some manufactories, are all performed by distinct hands, though in others the same man will sometimes perform two or three of them. I have seen a small manufactory of this kind where ten men only were employed, and where some of them consequently performed two or three distinct operations. But though they were very poor, and therefore but indifferently accommodated with the necessary machinery, they could, when they exerted themselves, make among them about twelve pounds of pins in a day. 4 There are in a pound upwards of four thousand pins of a middling size. Those ten persons, therefore, could make among them upwards of forty-eight thousand pins in a day. Each person, therefore, making a tenth part of forty-eight thousand pins, might be considered as making four thousand eight hundred pins in a day. But if they had all wrought separately and independently, and without any of them having been educated to this peculiar business, they certainly could not each of them have made twenty, perhaps not one pin in a day; that is, certainly, not the two hundred and fortieth, perhaps not the four thousand eight hundredth part of what they are at present capable of performing, in consequence of [9] a proper division and combination of their different operations. 4 In every other art and manufacture, the effects of the division of labour are similar to what they are in this very trifling one; though, in many of them, the labour can neither be so much subdivided, nor reduced to so great a simplicity of operation. The division of labour, however, so far as it can be introduced, occasions, in every art, a proportionable increase of the productive powers of labour. The separation of different trades and employments from one another, seems to have taken place, in consequence of this advantage. This separation too is generally carried furthest in those countries which enjoy the highest degree of industry and improvement; what is the work of one man, in a rude state of society, being generally that of several in an improved one. In every improved society, the farmer is generally nothing but a farmer; the manufacturer, nothing but a manufactures The labour too which is necessary to produce any one complete manufacture, is almost always divided among a great number of hands. How many different trades are employed in each branch of the linen and woollen manufactures, from the growers of the flax and the wool, to the bleachers and smoothers of the linen, or to the dyers and dressers of the cloth[ The nature of agriculture, indeed, does not admit of so many subdivisions of labour, nor of so complete a separation of one business from another, as manufactures.6 It is impossible to separate so entirely, the business of the grazer from that of the corn-farmer, as the trade of the carpenter is commonly separated from that of the smith. The spinner is almost always a distinct person from the weaver; but the ploughman, the harrower, the sower of the seed, and the reaper of the corn, are often the same. 7The occasions for those different sorts of labour returning with the different seasons of the year, it is impossible that one man should be constantly employed in any one of them. This impossibility of m_ing so complete and entire a separation of all the different branches of labour employed in agriculture, is perhaps the reason why the improvement of the productive powers of labour in this art, does not always keep pace with their improvement in manufactures. The most opulent nations, indeed, generally excel all their neighbours in agriculture as well as in manufactures; but they are commonly more distinguished by their superiority in the latter than in the farmers Their lands are in general better cultivated, and having more labour and expence bestowed upon them, produce more, in proportion to the extent and natural fertility of the ground. But this superiority of produce is seldom much more than in proportion to the superiority of labour and expence. In agriculture, the labour of the rich country is not always much more productive than that of the poor; or, at least, it is never so much more productive, as it commonly is in manufactures. The corn of the rich country, therefore, will not always, in the same degree of goodness, come cheaper to [ix] market than that of the poor. The corn of Poland, in the same degree of goodness, is as cheap as that of France, notwithstanding the superior opulence and improvement of the latter country. The corn of France is, in the corn provinces, fully as good, and in most years nearly about the same price with the corn of England, though, in opulence and improvement, France is perhaps inferior to England. The acorn-lands of England, however, are better cultivated than those of France, and the acorn-lands f France are said to be much better cultivated than those of Poland. But though the poor country, notwithstanding the inferiority of its cultivation, can, in some measure, rival the rich in the cheapness and goodness of its corn, it can pretend to no such competition in its manufactures; at least if those manufactures suit the soil, climate, and situation of the rich country. The silks of France are better and cheaper than those of England, because the silk manufacture, _at least under the present high duties upon the importation of raw silk/does not so well suit the climate of England has that of France. n But the hard-ware and the coarse woolens of England are beyond all comparison superior to those of France, and much cheaper too in the same degree of goodness. 9 In Poland there are said to be scarce any manufactures of any kind, a few of those coarser household manufactures excepted, without which no country can well subsist.
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Respond to the prompt using only information provided in the context block. Do not use any external knowledge or information not present in the given text. Your response should focus on providing factual details from the text. Use formal language and avoid any personal opinions or interpretations. If the prompt asks about something not covered in the context, state that the information is not available in the given text. What specific example does the author use to illustrate the effects of division of labor in a "very trifling manufacture"? THE greatest improvement in the productive powers of labour, and the greater part of the skill, dexterity, and judgment with which it is any where directed, or applied, seem to have been the effects of the division of labour. The effects of the division of labour, in the general business of society, will be more easily understood, by considering in what manner it operates in some particular manufactures. It is commonly supposed to be carried i furthest in some very trifling ones; not perhaps that it really is carried further in them than in others of more importance: but in those trifling manufactures which are destined to supply the small wants of but a small number of people, the whole number of workmen must necessarily be small; and those employed in every different branch of the work can often be collected into the same [7] workhouse, and placed at once under the view of the spectator. In those great manufactures, on the contrary, which are _- destined to supply the great wants of the great body of the people, every different branch of the work employs so great a number of workmen, that it is impossible to collect them all into the same workhouse. We can seldom b see more, at one time, than those employed in one single branch. Though [ bin such manufactures, b therefore, the work may really be divided into a r much greater number of parts, than in those of a more trifling nature, the division is not near so obvious, and has accordingly been much less observed. 3 To take an example, therefore, from a very trifling manufacture; but one in which the division of labour has been very often taken notice of, the trade of the pin-maker; a workman not educated to this business (which the division of labour has rendered a distinct trade), nor acquainted with the use of the machinery employed in it (to the invention of which the same division of labour has probably given occasion), could scarce, perhaps, with his utmost industry, make one pin in a day, and certainly could not make twenty. 2 But in the way in which this business is now carried on, not only the whole work is a peculiar trade, but it is divided into a number of branches, of which the greater part are likewise peculiar trades. One man draws out the wire, another straights it, a third cuts it, a fourth points it, a fifth grinds it at the top for receiving the head; to make the head requires [8] two or three distinct operations; to put it on, is a peculiar business, to whiten the pins is another; it is even a trade by itself to put them into the paper; and the important business of making a pin is, in this manner, divided into about eighteen distinct operations, 3 which, in some manufactories, are all performed by distinct hands, though in others the same man will sometimes perform two or three of them. I have seen a small manufactory of this kind where ten men only were employed, and where some of them consequently performed two or three distinct operations. But though they were very poor, and therefore but indifferently accommodated with the necessary machinery, they could, when they exerted themselves, make among them about twelve pounds of pins in a day. 4 There are in a pound upwards of four thousand pins of a middling size. Those ten persons, therefore, could make among them upwards of forty-eight thousand pins in a day. Each person, therefore, making a tenth part of forty-eight thousand pins, might be considered as making four thousand eight hundred pins in a day. But if they had all wrought separately and independently, and without any of them having been educated to this peculiar business, they certainly could not each of them have made twenty, perhaps not one pin in a day; that is, certainly, not the two hundred and fortieth, perhaps not the four thousand eight hundredth part of what they are at present capable of performing, in consequence of [9] a proper division and combination of their different operations. 4 In every other art and manufacture, the effects of the division of labour are similar to what they are in this very trifling one; though, in many of them, the labour can neither be so much subdivided, nor reduced to so great a simplicity of operation. The division of labour, however, so far as it can be introduced, occasions, in every art, a proportionable increase of the productive powers of labour. The separation of different trades and employments from one another, seems to have taken place, in consequence of this advantage. This separation too is generally carried furthest in those countries which enjoy the highest degree of industry and improvement; what is the work of one man, in a rude state of society, being generally that of several in an improved one. In every improved society, the farmer is generally nothing but a farmer; the manufacturer, nothing but a manufactures The labour too which is necessary to produce any one complete manufacture, is almost always divided among a great number of hands. How many different trades are employed in each branch of the linen and woollen manufactures, from the growers of the flax and the wool, to the bleachers and smoothers of the linen, or to the dyers and dressers of the cloth[ The nature of agriculture, indeed, does not admit of so many subdivisions of labour, nor of so complete a separation of one business from another, as manufactures.6 It is impossible to separate so entirely, the business of the grazer from that of the corn-farmer, as the trade of the carpenter is commonly separated from that of the smith. The spinner is almost always a distinct person from the weaver; but the ploughman, the harrower, the sower of the seed, and the reaper of the corn, are often the same. 7The occasions for those different sorts of labour returning with the different seasons of the year, it is impossible that one man should be constantly employed in any one of them. This impossibility of m_ing so complete and entire a separation of all the different branches of labour employed in agriculture, is perhaps the reason why the improvement of the productive powers of labour in this art, does not always keep pace with their improvement in manufactures. The most opulent nations, indeed, generally excel all their neighbours in agriculture as well as in manufactures; but they are commonly more distinguished by their superiority in the latter than in the farmers Their lands are in general better cultivated, and having more labour and expence bestowed upon them, produce more, in proportion to the extent and natural fertility of the ground. But this superiority of produce is seldom much more than in proportion to the superiority of labour and expence. In agriculture, the labour of the rich country is not always much more productive than that of the poor; or, at least, it is never so much more productive, as it commonly is in manufactures. The corn of the rich country, therefore, will not always, in the same degree of goodness, come cheaper to [ix] market than that of the poor. The corn of Poland, in the same degree of goodness, is as cheap as that of France, notwithstanding the superior opulence and improvement of the latter country. The corn of France is, in the corn provinces, fully as good, and in most years nearly about the same price with the corn of England, though, in opulence and improvement, France is perhaps inferior to England. The acorn-lands of England, however, are better cultivated than those of France, and the acorn-lands f France are said to be much better cultivated than those of Poland. But though the poor country, notwithstanding the inferiority of its cultivation, can, in some measure, rival the rich in the cheapness and goodness of its corn, it can pretend to no such competition in its manufactures; at least if those manufactures suit the soil, climate, and situation of the rich country. The silks of France are better and cheaper than those of England, because the silk manufacture, _at least under the present high duties upon the importation of raw silk/does not so well suit the climate of England has that of France. n But the hard-ware and the coarse woolens of England are beyond all comparison superior to those of France, and much cheaper too in the same degree of goodness. 9 In Poland there are said to be scarce any manufactures of any kind, a few of those coarser household manufactures excepted, without which no country can well subsist.
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Respond to the prompt using only information provided in the context block. Do not use any external knowledge or information not present in the given text. Your response should focus on providing factual details from the text. Use formal language and avoid any personal opinions or interpretations. If the prompt asks about something not covered in the context, state that the information is not available in the given text.
EVIDENCE:
THE greatest improvement in the productive powers of labour, and the greater part of the skill, dexterity, and judgment with which it is any where directed, or applied, seem to have been the effects of the division of labour. The effects of the division of labour, in the general business of society, will be more easily understood, by considering in what manner it operates in some particular manufactures. It is commonly supposed to be carried i furthest in some very trifling ones; not perhaps that it really is carried further in them than in others of more importance: but in those trifling manufactures which are destined to supply the small wants of but a small number of people, the whole number of workmen must necessarily be small; and those employed in every different branch of the work can often be collected into the same [7] workhouse, and placed at once under the view of the spectator. In those great manufactures, on the contrary, which are _- destined to supply the great wants of the great body of the people, every different branch of the work employs so great a number of workmen, that it is impossible to collect them all into the same workhouse. We can seldom b see more, at one time, than those employed in one single branch. Though [ bin such manufactures, b therefore, the work may really be divided into a r much greater number of parts, than in those of a more trifling nature, the division is not near so obvious, and has accordingly been much less observed. 3 To take an example, therefore, from a very trifling manufacture; but one in which the division of labour has been very often taken notice of, the trade of the pin-maker; a workman not educated to this business (which the division of labour has rendered a distinct trade), nor acquainted with the use of the machinery employed in it (to the invention of which the same division of labour has probably given occasion), could scarce, perhaps, with his utmost industry, make one pin in a day, and certainly could not make twenty. 2 But in the way in which this business is now carried on, not only the whole work is a peculiar trade, but it is divided into a number of branches, of which the greater part are likewise peculiar trades. One man draws out the wire, another straights it, a third cuts it, a fourth points it, a fifth grinds it at the top for receiving the head; to make the head requires [8] two or three distinct operations; to put it on, is a peculiar business, to whiten the pins is another; it is even a trade by itself to put them into the paper; and the important business of making a pin is, in this manner, divided into about eighteen distinct operations, 3 which, in some manufactories, are all performed by distinct hands, though in others the same man will sometimes perform two or three of them. I have seen a small manufactory of this kind where ten men only were employed, and where some of them consequently performed two or three distinct operations. But though they were very poor, and therefore but indifferently accommodated with the necessary machinery, they could, when they exerted themselves, make among them about twelve pounds of pins in a day. 4 There are in a pound upwards of four thousand pins of a middling size. Those ten persons, therefore, could make among them upwards of forty-eight thousand pins in a day. Each person, therefore, making a tenth part of forty-eight thousand pins, might be considered as making four thousand eight hundred pins in a day. But if they had all wrought separately and independently, and without any of them having been educated to this peculiar business, they certainly could not each of them have made twenty, perhaps not one pin in a day; that is, certainly, not the two hundred and fortieth, perhaps not the four thousand eight hundredth part of what they are at present capable of performing, in consequence of [9] a proper division and combination of their different operations. 4 In every other art and manufacture, the effects of the division of labour are similar to what they are in this very trifling one; though, in many of them, the labour can neither be so much subdivided, nor reduced to so great a simplicity of operation. The division of labour, however, so far as it can be introduced, occasions, in every art, a proportionable increase of the productive powers of labour. The separation of different trades and employments from one another, seems to have taken place, in consequence of this advantage. This separation too is generally carried furthest in those countries which enjoy the highest degree of industry and improvement; what is the work of one man, in a rude state of society, being generally that of several in an improved one. In every improved society, the farmer is generally nothing but a farmer; the manufacturer, nothing but a manufactures The labour too which is necessary to produce any one complete manufacture, is almost always divided among a great number of hands. How many different trades are employed in each branch of the linen and woollen manufactures, from the growers of the flax and the wool, to the bleachers and smoothers of the linen, or to the dyers and dressers of the cloth[ The nature of agriculture, indeed, does not admit of so many subdivisions of labour, nor of so complete a separation of one business from another, as manufactures.6 It is impossible to separate so entirely, the business of the grazer from that of the corn-farmer, as the trade of the carpenter is commonly separated from that of the smith. The spinner is almost always a distinct person from the weaver; but the ploughman, the harrower, the sower of the seed, and the reaper of the corn, are often the same. 7The occasions for those different sorts of labour returning with the different seasons of the year, it is impossible that one man should be constantly employed in any one of them. This impossibility of m_ing so complete and entire a separation of all the different branches of labour employed in agriculture, is perhaps the reason why the improvement of the productive powers of labour in this art, does not always keep pace with their improvement in manufactures. The most opulent nations, indeed, generally excel all their neighbours in agriculture as well as in manufactures; but they are commonly more distinguished by their superiority in the latter than in the farmers Their lands are in general better cultivated, and having more labour and expence bestowed upon them, produce more, in proportion to the extent and natural fertility of the ground. But this superiority of produce is seldom much more than in proportion to the superiority of labour and expence. In agriculture, the labour of the rich country is not always much more productive than that of the poor; or, at least, it is never so much more productive, as it commonly is in manufactures. The corn of the rich country, therefore, will not always, in the same degree of goodness, come cheaper to [ix] market than that of the poor. The corn of Poland, in the same degree of goodness, is as cheap as that of France, notwithstanding the superior opulence and improvement of the latter country. The corn of France is, in the corn provinces, fully as good, and in most years nearly about the same price with the corn of England, though, in opulence and improvement, France is perhaps inferior to England. The acorn-lands of England, however, are better cultivated than those of France, and the acorn-lands f France are said to be much better cultivated than those of Poland. But though the poor country, notwithstanding the inferiority of its cultivation, can, in some measure, rival the rich in the cheapness and goodness of its corn, it can pretend to no such competition in its manufactures; at least if those manufactures suit the soil, climate, and situation of the rich country. The silks of France are better and cheaper than those of England, because the silk manufacture, _at least under the present high duties upon the importation of raw silk/does not so well suit the climate of England has that of France. n But the hard-ware and the coarse woolens of England are beyond all comparison superior to those of France, and much cheaper too in the same degree of goodness. 9 In Poland there are said to be scarce any manufactures of any kind, a few of those coarser household manufactures excepted, without which no country can well subsist.
USER:
What specific example does the author use to illustrate the effects of division of labor in a "very trifling manufacture"?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 69 | 20 | 1,459 | null | 129 |
"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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How is a screen test for Colorectal cancer performed and what makes one more likely to get it? How much smoking should I have done in order to need a screening for lung cancer?
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## Colorectal cancer Colorectal cancer is cancer that starts in the colon or rectum. Some factors that increase colorectal cancer risk include physical inactivity, a diet high in red and processed meats, excess body weight, smoking, alcohol use, and a personal or family history of colorectal cancer or polyps. ### What you can do #### Get screened. Regular colorectal cancer screening is one of the best ways to prevent colorectal cancer. Most colorectal cancers start with a polyp – a small growth in the colon or rectum. Screening can help to find colorectal cancer early, when it’s smaller, hasn’t spread, and might be easier to treat. Certain screening tests can also help prevent colorectal cancer by finding and removing polyps before they turn into cancer. The American Cancer Society recommends the following for people at average risk for colorectal cancer: - **Everyone** **should start regular screening at** **age 45.** - People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening **through** **age** **75.** - **For people ages 76 to** **85,** the decision to be screened should be based on a person’s preferences, life expectancy, health, and screening history. - **People over age** **85** should no longer get colorectal cancer screening. Screening can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below. ### Screening tests for colorectal cancer #### Stool-based tests - Fecal immunochemical test (FIT)* every year, **or** - Guaiac-based fecal occult blood test (gFOBT)* every year, **or** - Stool DNA test (MT-sDNA) every 3 years* #### Visual (structural) exams of the colon and rectum - Colonoscopy every 10 years, **or** - CT colonography (virtual colonoscopy)* every 5 years, **or** - Flexible sigmoidoscopy* every 5 years *If a person gets screened with a test other than colonoscopy, any abnormal test result should be followed up with colonoscopy. If you're at high risk of colorectal cancer based on family history or other factors, you may need to start screening before age 45, be screened more often, or get specific tests. There are some differences between these tests to consider, **but the most important thing is to get screened, no matter which test you choose.** Talk to a health care provider about which tests might be good options for you, and to your insurance provider about your coverage. If you don't have insurance or can't afford cancer screening, [find free and low-cost screening options.](https://www.cancer.org/cancer/screening/get-screened.html) ## Lung cancer [Lung cancer](https://www.cancer.org/cancer/types/lung-cancer.html) is the second most common type of cancer in men in the US and the leading cause of cancer death. ### What you can do #### Get screened. The American Cancer Society recommends yearly lung cancer screening with a low-dose CT (LDCT) scan for people who: - **Are ages 50 to 80 years** and smoke or used to smoke **AND** - **Have at least a 20 pack-year history of smoking** (A pack-year is equal to smoking 1 pack of cigarettes per day for a year. For example, a person could have a 20 pack-year history by smoking 1 pack a day for 20 years or by smoking 2 packs a day for 10 years.) Before deciding to get screened, people should talk to their health care provider about the purpose of screening, how it's done, the benefits, limitations, and possible harms of screening. People who still smoke should be counseled about quitting and offered resources to help them quit. #### Avoid tobacco and exposures. Not all lung cancers are preventable. But there are things you can do to lower your risk. - If you don’t smoke, don’t start. Avoid breathing in other people’s smoke. - If you smoke, call the American Cancer Society at 1-800-227-2345 or visit [Empowered to Quit](https://www.cancer.org/cancer/risk-prevention/tobacco/empowered-to-quit.html) for help quitting. While smoking tobacco is the leading cause of cancer, not all people who get lung cancer smoke. Other ways you can help lower your risk: - Avoid all products with tobacco. - Stay away from secondhand smoke. - Avoid or limit exposure to cancer-causing chemicals that might be in the home or workplace.
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"================ <TEXT PASSAGE> ======= ## Colorectal cancer Colorectal cancer is cancer that starts in the colon or rectum. Some factors that increase colorectal cancer risk include physical inactivity, a diet high in red and processed meats, excess body weight, smoking, alcohol use, and a personal or family history of colorectal cancer or polyps. ### What you can do #### Get screened. Regular colorectal cancer screening is one of the best ways to prevent colorectal cancer. Most colorectal cancers start with a polyp – a small growth in the colon or rectum. Screening can help to find colorectal cancer early, when it’s smaller, hasn’t spread, and might be easier to treat. Certain screening tests can also help prevent colorectal cancer by finding and removing polyps before they turn into cancer. The American Cancer Society recommends the following for people at average risk for colorectal cancer: - **Everyone** **should start regular screening at** **age 45.** - People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening **through** **age** **75.** - **For people ages 76 to** **85,** the decision to be screened should be based on a person’s preferences, life expectancy, health, and screening history. - **People over age** **85** should no longer get colorectal cancer screening. Screening can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below. ### Screening tests for colorectal cancer #### Stool-based tests - Fecal immunochemical test (FIT)* every year, **or** - Guaiac-based fecal occult blood test (gFOBT)* every year, **or** - Stool DNA test (MT-sDNA) every 3 years* #### Visual (structural) exams of the colon and rectum - Colonoscopy every 10 years, **or** - CT colonography (virtual colonoscopy)* every 5 years, **or** - Flexible sigmoidoscopy* every 5 years *If a person gets screened with a test other than colonoscopy, any abnormal test result should be followed up with colonoscopy. If you're at high risk of colorectal cancer based on family history or other factors, you may need to start screening before age 45, be screened more often, or get specific tests. There are some differences between these tests to consider, **but the most important thing is to get screened, no matter which test you choose.** Talk to a health care provider about which tests might be good options for you, and to your insurance provider about your coverage. If you don't have insurance or can't afford cancer screening, [find free and low-cost screening options.](https://www.cancer.org/cancer/screening/get-screened.html) ## Lung cancer [Lung cancer](https://www.cancer.org/cancer/types/lung-cancer.html) is the second most common type of cancer in men in the US and the leading cause of cancer death. ### What you can do #### Get screened. The American Cancer Society recommends yearly lung cancer screening with a low-dose CT (LDCT) scan for people who: - **Are ages 50 to 80 years** and smoke or used to smoke **AND** - **Have at least a 20 pack-year history of smoking** (A pack-year is equal to smoking 1 pack of cigarettes per day for a year. For example, a person could have a 20 pack-year history by smoking 1 pack a day for 20 years or by smoking 2 packs a day for 10 years.) Before deciding to get screened, people should talk to their health care provider about the purpose of screening, how it's done, the benefits, limitations, and possible harms of screening. People who still smoke should be counseled about quitting and offered resources to help them quit. #### Avoid tobacco and exposures. Not all lung cancers are preventable. But there are things you can do to lower your risk. - If you don’t smoke, don’t start. Avoid breathing in other people’s smoke. - If you smoke, call the American Cancer Society at 1-800-227-2345 or visit [Empowered to Quit](https://www.cancer.org/cancer/risk-prevention/tobacco/empowered-to-quit.html) for help quitting. While smoking tobacco is the leading cause of cancer, not all people who get lung cancer smoke. Other ways you can help lower your risk: - Avoid all products with tobacco. - Stay away from secondhand smoke. - Avoid or limit exposure to cancer-causing chemicals that might be in the home or workplace. https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/cancer-facts/cancer-facts-for-men.html ================ <QUESTION> ======= How is a screen test for Colorectal cancer performed and what makes one more likely to get it? How much smoking should I have done in order to need a screening for lung cancer? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
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"================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided."
EVIDENCE:
## Colorectal cancer Colorectal cancer is cancer that starts in the colon or rectum. Some factors that increase colorectal cancer risk include physical inactivity, a diet high in red and processed meats, excess body weight, smoking, alcohol use, and a personal or family history of colorectal cancer or polyps. ### What you can do #### Get screened. Regular colorectal cancer screening is one of the best ways to prevent colorectal cancer. Most colorectal cancers start with a polyp – a small growth in the colon or rectum. Screening can help to find colorectal cancer early, when it’s smaller, hasn’t spread, and might be easier to treat. Certain screening tests can also help prevent colorectal cancer by finding and removing polyps before they turn into cancer. The American Cancer Society recommends the following for people at average risk for colorectal cancer: - **Everyone** **should start regular screening at** **age 45.** - People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening **through** **age** **75.** - **For people ages 76 to** **85,** the decision to be screened should be based on a person’s preferences, life expectancy, health, and screening history. - **People over age** **85** should no longer get colorectal cancer screening. Screening can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below. ### Screening tests for colorectal cancer #### Stool-based tests - Fecal immunochemical test (FIT)* every year, **or** - Guaiac-based fecal occult blood test (gFOBT)* every year, **or** - Stool DNA test (MT-sDNA) every 3 years* #### Visual (structural) exams of the colon and rectum - Colonoscopy every 10 years, **or** - CT colonography (virtual colonoscopy)* every 5 years, **or** - Flexible sigmoidoscopy* every 5 years *If a person gets screened with a test other than colonoscopy, any abnormal test result should be followed up with colonoscopy. If you're at high risk of colorectal cancer based on family history or other factors, you may need to start screening before age 45, be screened more often, or get specific tests. There are some differences between these tests to consider, **but the most important thing is to get screened, no matter which test you choose.** Talk to a health care provider about which tests might be good options for you, and to your insurance provider about your coverage. If you don't have insurance or can't afford cancer screening, [find free and low-cost screening options.](https://www.cancer.org/cancer/screening/get-screened.html) ## Lung cancer [Lung cancer](https://www.cancer.org/cancer/types/lung-cancer.html) is the second most common type of cancer in men in the US and the leading cause of cancer death. ### What you can do #### Get screened. The American Cancer Society recommends yearly lung cancer screening with a low-dose CT (LDCT) scan for people who: - **Are ages 50 to 80 years** and smoke or used to smoke **AND** - **Have at least a 20 pack-year history of smoking** (A pack-year is equal to smoking 1 pack of cigarettes per day for a year. For example, a person could have a 20 pack-year history by smoking 1 pack a day for 20 years or by smoking 2 packs a day for 10 years.) Before deciding to get screened, people should talk to their health care provider about the purpose of screening, how it's done, the benefits, limitations, and possible harms of screening. People who still smoke should be counseled about quitting and offered resources to help them quit. #### Avoid tobacco and exposures. Not all lung cancers are preventable. But there are things you can do to lower your risk. - If you don’t smoke, don’t start. Avoid breathing in other people’s smoke. - If you smoke, call the American Cancer Society at 1-800-227-2345 or visit [Empowered to Quit](https://www.cancer.org/cancer/risk-prevention/tobacco/empowered-to-quit.html) for help quitting. While smoking tobacco is the leading cause of cancer, not all people who get lung cancer smoke. Other ways you can help lower your risk: - Avoid all products with tobacco. - Stay away from secondhand smoke. - Avoid or limit exposure to cancer-causing chemicals that might be in the home or workplace.
USER:
How is a screen test for Colorectal cancer performed and what makes one more likely to get it? How much smoking should I have done in order to need a screening for lung cancer?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| true | 49 | 34 | 705 | null | 842 |
Provide your answer in full sentences, referencing the document using quotations.
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According to the 2010 COSTCO Code of Ethics as found in the Employee Agreement document, how can COSTCO employees earn the trust of COSTCO members?
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**COSTCO Code of Ethics from Employee Agreement -- 2010** Our Mission To continually provide our members with quality goods and services at the lowest possible prices. In order to achieve our mission we will conduct our business with the following Code of Ethics in mind: Our Code of Ethics 1. Obey the law. 2. Take care of our members. 3. Take care of our employees. 4. Respect our suppliers. If we do these four things throughout our organization, then we will achieve our ultimate goal, which is to: 5. Reward our shareholders. Costco’s Code of Ethics 1. Obey the law The law is irrefutable! Absent a moral imperative to challenge a law, we must conduct our business in total compliance with the laws of every community where we do business. We pledge to: Comply with all laws and other legal requirements. Respect all public officials and their positions. Comply with safety and security standards for all products sold. Alert management if we observe illegal workplace misconduct by other employees. Exceed ecological standards required in every community where we do business. Comply with all applicable wage and hour laws. Comply with all applicable antitrust laws. Conduct business in and with foreign countries in a manner that is legal and proper under United States and foreign laws. Not offer or give any form of bribe or kickback or other thing of value to any person or pay to obtain or expedite government action or otherwise act in violation of the Foreign Corrupt Practices Act or the laws of other countries. Not request or receive any bribe or kickback. Promote fair, accurate, timely, and understandable disclosure in reports filed with the Securities and Exchange Commission and in other public communications by the Company. 1.0 Costco Mission Statement and Code of Ethics – updated March 2010 2. Take care of our members Costco membership is open to business owners, as well as individuals. Our members are our reason for being – the key to our success. If we don’t keep our members happy, little else that we do will make a difference. There are plenty of shopping alternatives for our members and if they fail to show up, we cannot survive. Our members have extended a trust to Costco by virtue of paying a fee to shop with us. We will succeed only if we do not violate the trust they have extended to us, and that trust extends to every area of our business. To continue to earn their trust, we pledge to: Provide top-quality products at the best prices in the market. Provide high quality, safe and wholesome food products by requiring that both suppliers and employees be in compliance with the highest food safety standards in the industry. Provide our members with a 100% satisfaction guarantee on every product and service we sell, including their membership fee. Assure our members that every product we sell is authentic in make and in representation of performance. Make our shopping environment a pleasant experience by making our members feel welcome as our guests. Provide products to our members that will be ecologically sensitive. Provide our members with the best customer service in the retail industry. Give back to our communities through employee volunteerism and employee and corporate contributions to United Way and Children’s Hospitals. 3. Take care of our employees Our employees are our most important asset. We believe we have the very best employees in the warehouse club industry, and we are committed to providing them with rewarding challenges and ample opportunities for personal and career growth. We pledge to provide our employees with: Competitive wages Great benefits A safe and healthy work environment Challenging and fun work Career opportunities An atmosphere free from harassment or discrimination An Open Door Policy that allows access to ascending levels of management to resolve issues Opportunities to give back to their communities through volunteerism and fund-raising 1.0 Career Opportunities at Costco: Costco is committed to promoting from within the Company. The majority of our current management team members (including Warehouse, Merchandise, Administrative, Membership, Front End and Receiving Managers) are “home grown.” Our growth plans remain very aggressive and our need for qualified, experienced employees to fill supervisory and management positions remains great. Today we have Location Managers and Vice Presidents who were once Stockers and Callers or who started in clerical positions for Costco. We believe that Costco’s future Costco Mission Statement and Code of Ethics – updated March 2010 executive officers are currently working in our warehouses, depots and buying offices, as well as in our Home Office. 4. Respect our suppliers Our suppliers are our partners in business and for us to prosper as a company, they must prosper with us. To that end, we strive to: Treat all suppliers and their representatives as we would expect to be treated if visiting their places of business. Honor all commitments. Protect all suppliers’ property assigned to Costco as though it were our own. Not accept gratuities of any kind from a supplier. These guidelines are exactly that – guidelines – some common sense rules for the conduct of our business. At the core of our philosophy as a company is the implicit understanding that all of us, employees and management alike, must conduct ourselves in an honest and ethical manner every day. Dishonest conduct will not be tolerated. To do any less would be unfair to the overwhelming majority of our employees who support and respect Costco’s commitment to ethical business conduct. Our employees must avoid actual or apparent conflicts of interest, including creating a business in competition with the Company or working for or on behalf of another employer in competition with the Company. If you are ever in doubt as to what course of action to take on a business matter that is open to varying ethical interpretations, TAKE THE HIGH ROAD AND DO WHAT IS RIGHT. If we follow the four principles of our Code of Ethics throughout our organization, then we will achieve our fifth principle and ultimate goal, which is to: 1.0 5. Reward our shareholders As a company with stock that is traded publicly on the NASDAQ Stock Market, our shareholders are our business partners. We can only be successful so long as we are providing them with a good return on the money they invest in our Company. This, too, involves the element of trust. They trust us to use their investment wisely and to operate our business in such a way that it is profitable. Over the years Costco has been in business, we have consistently followed an upward trend in the value of our stock. Yes, we have had our ups and our downs, but the overall trend has been consistently up. We believe Costco stock is a good investment, and we pledge to operate our Company in such a way that our present and future stockholders, as well as our employees, will be rewarded for our efforts. Costco Mission Statement and Code of Ethics – updated March 2010 Reporting of Violations and Enforcement 1. The Code of Ethics applies to all directors, officers, and employees of the Company. Conduct that violates the Code of Ethics will constitute grounds for disciplinary action, ranging from reprimand to termination and possible criminal prosecution. 2. All employees are expected to promptly report actual or suspected violations of law or the Code of Ethics. Federal law, other laws and Costco policy protect employees from retaliation if complaints are made in good faith. Violations involving employees should be reported to the responsible Executive Vice President, who shall be responsible for taking prompt and appropriate action to investigate and respond. Other violations (such as those involving suppliers) and those involving accounting, internal control and auditing should be reported to the general Counsel or the Chief Compliance Officer (999 Lake Drive, Issaquah, WA 98027), who shall be responsible for taking prompt and appropriate action to investigate and respond. Reports or complaints can also be made, confidentially if you choose, through the Whistleblower Policy link on the Company’s eNet or Intranet site. 1.0 What do Costco’s Mission Statement and Code of Ethics have to do with you? EVERYTHING! The continued success of our Company depends on how well each of Costco’s employees adheres to the high standards mandated by our Code of Ethics. And a successful company means increased opportunities for success and advancement for each of you. No matter what your current job, you can put Costco’s Code of Ethics to work every day. It’s reflected in the energy and enthusiasm you bring to work, in the relationships you build with your management, your co-workers, our suppliers and our members. By always choosing to do the right thing, you will build your own self-esteem, increase your chances for success and make Costco more successful, too. It is the synergy of ideas and talents, each of us working together and contributing our best, which makes Costco the great company it is today and lays the groundwork for what we will be tomorrow.
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<context> ================== **COSTCO Code of Ethics from Employee Agreement -- 2010** Our Mission To continually provide our members with quality goods and services at the lowest possible prices. In order to achieve our mission we will conduct our business with the following Code of Ethics in mind: Our Code of Ethics 1. Obey the law. 2. Take care of our members. 3. Take care of our employees. 4. Respect our suppliers. If we do these four things throughout our organization, then we will achieve our ultimate goal, which is to: 5. Reward our shareholders. Costco’s Code of Ethics 1. Obey the law The law is irrefutable! Absent a moral imperative to challenge a law, we must conduct our business in total compliance with the laws of every community where we do business. We pledge to: Comply with all laws and other legal requirements. Respect all public officials and their positions. Comply with safety and security standards for all products sold. Alert management if we observe illegal workplace misconduct by other employees. Exceed ecological standards required in every community where we do business. Comply with all applicable wage and hour laws. Comply with all applicable antitrust laws. Conduct business in and with foreign countries in a manner that is legal and proper under United States and foreign laws. Not offer or give any form of bribe or kickback or other thing of value to any person or pay to obtain or expedite government action or otherwise act in violation of the Foreign Corrupt Practices Act or the laws of other countries. Not request or receive any bribe or kickback. Promote fair, accurate, timely, and understandable disclosure in reports filed with the Securities and Exchange Commission and in other public communications by the Company. 1.0 Costco Mission Statement and Code of Ethics – updated March 2010 2. Take care of our members Costco membership is open to business owners, as well as individuals. Our members are our reason for being – the key to our success. If we don’t keep our members happy, little else that we do will make a difference. There are plenty of shopping alternatives for our members and if they fail to show up, we cannot survive. Our members have extended a trust to Costco by virtue of paying a fee to shop with us. We will succeed only if we do not violate the trust they have extended to us, and that trust extends to every area of our business. To continue to earn their trust, we pledge to: Provide top-quality products at the best prices in the market. Provide high quality, safe and wholesome food products by requiring that both suppliers and employees be in compliance with the highest food safety standards in the industry. Provide our members with a 100% satisfaction guarantee on every product and service we sell, including their membership fee. Assure our members that every product we sell is authentic in make and in representation of performance. Make our shopping environment a pleasant experience by making our members feel welcome as our guests. Provide products to our members that will be ecologically sensitive. Provide our members with the best customer service in the retail industry. Give back to our communities through employee volunteerism and employee and corporate contributions to United Way and Children’s Hospitals. 3. Take care of our employees Our employees are our most important asset. We believe we have the very best employees in the warehouse club industry, and we are committed to providing them with rewarding challenges and ample opportunities for personal and career growth. We pledge to provide our employees with: Competitive wages Great benefits A safe and healthy work environment Challenging and fun work Career opportunities An atmosphere free from harassment or discrimination An Open Door Policy that allows access to ascending levels of management to resolve issues Opportunities to give back to their communities through volunteerism and fund-raising 1.0 Career Opportunities at Costco: Costco is committed to promoting from within the Company. The majority of our current management team members (including Warehouse, Merchandise, Administrative, Membership, Front End and Receiving Managers) are “home grown.” Our growth plans remain very aggressive and our need for qualified, experienced employees to fill supervisory and management positions remains great. Today we have Location Managers and Vice Presidents who were once Stockers and Callers or who started in clerical positions for Costco. We believe that Costco’s future Costco Mission Statement and Code of Ethics – updated March 2010 executive officers are currently working in our warehouses, depots and buying offices, as well as in our Home Office. 4. Respect our suppliers Our suppliers are our partners in business and for us to prosper as a company, they must prosper with us. To that end, we strive to: Treat all suppliers and their representatives as we would expect to be treated if visiting their places of business. Honor all commitments. Protect all suppliers’ property assigned to Costco as though it were our own. Not accept gratuities of any kind from a supplier. These guidelines are exactly that – guidelines – some common sense rules for the conduct of our business. At the core of our philosophy as a company is the implicit understanding that all of us, employees and management alike, must conduct ourselves in an honest and ethical manner every day. Dishonest conduct will not be tolerated. To do any less would be unfair to the overwhelming majority of our employees who support and respect Costco’s commitment to ethical business conduct. Our employees must avoid actual or apparent conflicts of interest, including creating a business in competition with the Company or working for or on behalf of another employer in competition with the Company. If you are ever in doubt as to what course of action to take on a business matter that is open to varying ethical interpretations, TAKE THE HIGH ROAD AND DO WHAT IS RIGHT. If we follow the four principles of our Code of Ethics throughout our organization, then we will achieve our fifth principle and ultimate goal, which is to: 1.0 5. Reward our shareholders As a company with stock that is traded publicly on the NASDAQ Stock Market, our shareholders are our business partners. We can only be successful so long as we are providing them with a good return on the money they invest in our Company. This, too, involves the element of trust. They trust us to use their investment wisely and to operate our business in such a way that it is profitable. Over the years Costco has been in business, we have consistently followed an upward trend in the value of our stock. Yes, we have had our ups and our downs, but the overall trend has been consistently up. We believe Costco stock is a good investment, and we pledge to operate our Company in such a way that our present and future stockholders, as well as our employees, will be rewarded for our efforts. Costco Mission Statement and Code of Ethics – updated March 2010 Reporting of Violations and Enforcement 1. The Code of Ethics applies to all directors, officers, and employees of the Company. Conduct that violates the Code of Ethics will constitute grounds for disciplinary action, ranging from reprimand to termination and possible criminal prosecution. 2. All employees are expected to promptly report actual or suspected violations of law or the Code of Ethics. Federal law, other laws and Costco policy protect employees from retaliation if complaints are made in good faith. Violations involving employees should be reported to the responsible Executive Vice President, who shall be responsible for taking prompt and appropriate action to investigate and respond. Other violations (such as those involving suppliers) and those involving accounting, internal control and auditing should be reported to the general Counsel or the Chief Compliance Officer (999 Lake Drive, Issaquah, WA 98027), who shall be responsible for taking prompt and appropriate action to investigate and respond. Reports or complaints can also be made, confidentially if you choose, through the Whistleblower Policy link on the Company’s eNet or Intranet site. 1.0 What do Costco’s Mission Statement and Code of Ethics have to do with you? EVERYTHING! The continued success of our Company depends on how well each of Costco’s employees adheres to the high standards mandated by our Code of Ethics. And a successful company means increased opportunities for success and advancement for each of you. No matter what your current job, you can put Costco’s Code of Ethics to work every day. It’s reflected in the energy and enthusiasm you bring to work, in the relationships you build with your management, your co-workers, our suppliers and our members. By always choosing to do the right thing, you will build your own self-esteem, increase your chances for success and make Costco more successful, too. It is the synergy of ideas and talents, each of us working together and contributing our best, which makes Costco the great company it is today and lays the groundwork for what we will be tomorrow. <task instructions> ================== Provide your answer in full sentences, referencing the document using quotations. <question> ================== According to the 2010 COSTCO Code of Ethics as found in the Employee Agreement document, how can COSTCO employees earn the trust of COSTCO members?
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Provide your answer in full sentences, referencing the document using quotations.
EVIDENCE:
**COSTCO Code of Ethics from Employee Agreement -- 2010** Our Mission To continually provide our members with quality goods and services at the lowest possible prices. In order to achieve our mission we will conduct our business with the following Code of Ethics in mind: Our Code of Ethics 1. Obey the law. 2. Take care of our members. 3. Take care of our employees. 4. Respect our suppliers. If we do these four things throughout our organization, then we will achieve our ultimate goal, which is to: 5. Reward our shareholders. Costco’s Code of Ethics 1. Obey the law The law is irrefutable! Absent a moral imperative to challenge a law, we must conduct our business in total compliance with the laws of every community where we do business. We pledge to: Comply with all laws and other legal requirements. Respect all public officials and their positions. Comply with safety and security standards for all products sold. Alert management if we observe illegal workplace misconduct by other employees. Exceed ecological standards required in every community where we do business. Comply with all applicable wage and hour laws. Comply with all applicable antitrust laws. Conduct business in and with foreign countries in a manner that is legal and proper under United States and foreign laws. Not offer or give any form of bribe or kickback or other thing of value to any person or pay to obtain or expedite government action or otherwise act in violation of the Foreign Corrupt Practices Act or the laws of other countries. Not request or receive any bribe or kickback. Promote fair, accurate, timely, and understandable disclosure in reports filed with the Securities and Exchange Commission and in other public communications by the Company. 1.0 Costco Mission Statement and Code of Ethics – updated March 2010 2. Take care of our members Costco membership is open to business owners, as well as individuals. Our members are our reason for being – the key to our success. If we don’t keep our members happy, little else that we do will make a difference. There are plenty of shopping alternatives for our members and if they fail to show up, we cannot survive. Our members have extended a trust to Costco by virtue of paying a fee to shop with us. We will succeed only if we do not violate the trust they have extended to us, and that trust extends to every area of our business. To continue to earn their trust, we pledge to: Provide top-quality products at the best prices in the market. Provide high quality, safe and wholesome food products by requiring that both suppliers and employees be in compliance with the highest food safety standards in the industry. Provide our members with a 100% satisfaction guarantee on every product and service we sell, including their membership fee. Assure our members that every product we sell is authentic in make and in representation of performance. Make our shopping environment a pleasant experience by making our members feel welcome as our guests. Provide products to our members that will be ecologically sensitive. Provide our members with the best customer service in the retail industry. Give back to our communities through employee volunteerism and employee and corporate contributions to United Way and Children’s Hospitals. 3. Take care of our employees Our employees are our most important asset. We believe we have the very best employees in the warehouse club industry, and we are committed to providing them with rewarding challenges and ample opportunities for personal and career growth. We pledge to provide our employees with: Competitive wages Great benefits A safe and healthy work environment Challenging and fun work Career opportunities An atmosphere free from harassment or discrimination An Open Door Policy that allows access to ascending levels of management to resolve issues Opportunities to give back to their communities through volunteerism and fund-raising 1.0 Career Opportunities at Costco: Costco is committed to promoting from within the Company. The majority of our current management team members (including Warehouse, Merchandise, Administrative, Membership, Front End and Receiving Managers) are “home grown.” Our growth plans remain very aggressive and our need for qualified, experienced employees to fill supervisory and management positions remains great. Today we have Location Managers and Vice Presidents who were once Stockers and Callers or who started in clerical positions for Costco. We believe that Costco’s future Costco Mission Statement and Code of Ethics – updated March 2010 executive officers are currently working in our warehouses, depots and buying offices, as well as in our Home Office. 4. Respect our suppliers Our suppliers are our partners in business and for us to prosper as a company, they must prosper with us. To that end, we strive to: Treat all suppliers and their representatives as we would expect to be treated if visiting their places of business. Honor all commitments. Protect all suppliers’ property assigned to Costco as though it were our own. Not accept gratuities of any kind from a supplier. These guidelines are exactly that – guidelines – some common sense rules for the conduct of our business. At the core of our philosophy as a company is the implicit understanding that all of us, employees and management alike, must conduct ourselves in an honest and ethical manner every day. Dishonest conduct will not be tolerated. To do any less would be unfair to the overwhelming majority of our employees who support and respect Costco’s commitment to ethical business conduct. Our employees must avoid actual or apparent conflicts of interest, including creating a business in competition with the Company or working for or on behalf of another employer in competition with the Company. If you are ever in doubt as to what course of action to take on a business matter that is open to varying ethical interpretations, TAKE THE HIGH ROAD AND DO WHAT IS RIGHT. If we follow the four principles of our Code of Ethics throughout our organization, then we will achieve our fifth principle and ultimate goal, which is to: 1.0 5. Reward our shareholders As a company with stock that is traded publicly on the NASDAQ Stock Market, our shareholders are our business partners. We can only be successful so long as we are providing them with a good return on the money they invest in our Company. This, too, involves the element of trust. They trust us to use their investment wisely and to operate our business in such a way that it is profitable. Over the years Costco has been in business, we have consistently followed an upward trend in the value of our stock. Yes, we have had our ups and our downs, but the overall trend has been consistently up. We believe Costco stock is a good investment, and we pledge to operate our Company in such a way that our present and future stockholders, as well as our employees, will be rewarded for our efforts. Costco Mission Statement and Code of Ethics – updated March 2010 Reporting of Violations and Enforcement 1. The Code of Ethics applies to all directors, officers, and employees of the Company. Conduct that violates the Code of Ethics will constitute grounds for disciplinary action, ranging from reprimand to termination and possible criminal prosecution. 2. All employees are expected to promptly report actual or suspected violations of law or the Code of Ethics. Federal law, other laws and Costco policy protect employees from retaliation if complaints are made in good faith. Violations involving employees should be reported to the responsible Executive Vice President, who shall be responsible for taking prompt and appropriate action to investigate and respond. Other violations (such as those involving suppliers) and those involving accounting, internal control and auditing should be reported to the general Counsel or the Chief Compliance Officer (999 Lake Drive, Issaquah, WA 98027), who shall be responsible for taking prompt and appropriate action to investigate and respond. Reports or complaints can also be made, confidentially if you choose, through the Whistleblower Policy link on the Company’s eNet or Intranet site. 1.0 What do Costco’s Mission Statement and Code of Ethics have to do with you? EVERYTHING! The continued success of our Company depends on how well each of Costco’s employees adheres to the high standards mandated by our Code of Ethics. And a successful company means increased opportunities for success and advancement for each of you. No matter what your current job, you can put Costco’s Code of Ethics to work every day. It’s reflected in the energy and enthusiasm you bring to work, in the relationships you build with your management, your co-workers, our suppliers and our members. By always choosing to do the right thing, you will build your own self-esteem, increase your chances for success and make Costco more successful, too. It is the synergy of ideas and talents, each of us working together and contributing our best, which makes Costco the great company it is today and lays the groundwork for what we will be tomorrow.
USER:
According to the 2010 COSTCO Code of Ethics as found in the Employee Agreement document, how can COSTCO employees earn the trust of COSTCO members?
Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.
| false | 11 | 25 | 1,547 | null | 293 |
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